Membership Application

INTERESTED IN BECOMING A MEMBER? Membership is available to anyone who resides, works, worships or attends school in, and businesses and other legal entities located in Kanawha, Putnam, Cabell, Wayne, Lincoln and Boone counties of West Virginia.

Complete the following information and submit application. One of our Member Service Representatives will contact you to setup an appointment for you to visit your local branch and complete your membership application. Note: To complete your application you must visit your local branch to sign signature card. Please bring Identification.

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions obtain, verify, and record information that identifies each person who opens or changes an existing account with WVFCU.

What this means for you: When you open a new account or change an existing account we will ask for your name, address, and social security number, date of birth and other information that will allow us to identify you. We will also ask to see your driver's license or other identifying documents.

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* Required Fields

General Information

Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information.

If you wish to apply for a loan as well, please note this in the Special Instructions/Comments field at the end of the application and the Credit Union will contact you. There is no need for you to fill out a seperate loan application as long as you include this information.

Will there be a co-applicant on this application?

type="radio" class="cms_form_radio" id="element_17_152685_1" name="element_152685" value="1 co-applicant" /> 1 co-applicant

type="radio" class="cms_form_radio" id="element_17_152685_2" name="element_152685" value="2 co-apllicants" /> 2 co-apllicants

class="cms_form_error">

Membership Eligibility:

Employer

type="checkbox" class="cms_form_checkbox" id="element_17_152605_1" name="element_152605[]" value="Family Member" /> Family Member

type="checkbox" class="cms_form_checkbox" id="element_17_152605_2" name="element_152605[]" value="Community" /> Community

class="cms_form_error">

If Employer, please list here:

If Family Member, please enter in name:

If Community, please describe:

Primary Applicant

Last Name:

First Name:

Middle Name:

Social Security Number:

Date of Birth:

_17_152627_year" aria-hidden="false" style="display: none;">Date of Birth: Year

Work Phone Number:

Cell or Other Phone:

Email Address:

Backup Withholding Tax:

I AM subject o backup withholding tax

type="radio" class="cms_form_radio" id="element_17_152629_1" name="element_152629" value="I AM NOT subject o backup withholding tax" /> I AM NOT subject o backup withholding tax

class="cms_form_error">

Citizenship:

I certify that I am a US Person (including US Resident Alien)

class="cms_form_error">

Driver's License #:

Driver's License State:

Home Address

Street Address:

Apt.:

City:

State:

Current Time at Residence:

Residence Type:

Own

type="radio" class="cms_form_radio" id="element_17_152657_1" name="element_152657" value="Rent" /> Rent

type="radio" class="cms_form_radio" id="element_17_152657_2" name="element_152657" value="Other" /> Other

class="cms_form_error">

If Other, please describe:

Mailing Address (if different)

Street Address:

Apt.:

City:

State:

Present Employer

Name:

Phone Number:

Job Title:

Job Start Date:

Street Address:

Suite:

City:

State:

Co-Applicant (if applicable)

Last Name:

First Name:

Middle Name:

Relationship to Primary Owner:

Social Security Number:

Date of Birth:

_17_152723_year" aria-hidden="false" style="display: none;">Date of Birth: Year

Work Phone Number:

Cell or Other Phone:

Email Address:

Driver's License #:

Driver's License State:

Home Address

Street Address:

Apt.:

City:

State:

Current Time at Residence:

Residence Type:

Own

type="radio" class="cms_form_radio" id="element_17_152757_1" name="element_152757" value="Rent" /> Rent

type="radio" class="cms_form_radio" id="element_17_152757_2" name="element_152757" value="Other" /> Other

class="cms_form_error">

If Other, please describe:

Mailing Address (if different)

Street Address:

Apt.:

City:

State:

Present Employer

Name:

Phone Number:

Job Title:

Job Start Date:

Street Address:

Stuie:

City:

State:

Co-Applicant 2 (if applicable)

Last Name:

First Name:

Middle Name:

Relationship to Primary Owner:

Social Security Number:

Date of Birth:

_17_152807_year" aria-hidden="false" style="display: none;">Date of Birth: Year

Work Phone Number:

Cell or Other Phone:

Email Address:

Driver's License #:

Driver's License State:

Home Address

Street Address:

Apt.:

City:

State:

Current Time at Residence:

Residence Type:

Own

type="radio" class="cms_form_radio" id="element_17_152675_1" name="element_152675" value="Rent" /> Rent

type="radio" class="cms_form_radio" id="element_17_152675_2" name="element_152675" value="Other" /> Other

class="cms_form_error">

If Other, please describe:

Mailing Address (if different)

Street Address:

Apt.:

City:

State:

Present Employer

Name:

Phone Number:

Job Title:

Job Start Date:

Street Address:

Stuie:

City:

State:

Nearest Relative Not Living With You

Last Name:

First Name:

Relationship:

Phone Number:

Street Address:

Apt.:

City:

State:

Additional Information

Special Instructions / Comments:

How would you like to be contacted?

Home Phone

type="radio" class="cms_form_radio" id="element_17_152841_1" name="element_152841" value="Work Phone" /> Work Phone

type="radio" class="cms_form_radio" id="element_17_152841_2" name="element_152841" value="Cell or Other Phone" /> Cell or Other Phone type="radio" class="cms_form_radio" id="element_17_152841_3" name="element_152841" value="Email" /> Email type="radio" class="cms_form_radio" id="element_17_152841_4" name="element_152841" value="Other" /> Other class="cms_form_error">

If Other, please describe:

TIN CERTIFCATION AND BACKUP WITHHOLDING INFORMATION Under penalties of perjury, I certify that:

The number shown on this form is my correct taxpayer identification number,

I am not subject to backup withholding because:
(a) I am exempt from backup withholding, or
(b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or
(c) the IRS has notified me that I am no longer subject to backup withholding, and
I am a U.S. person (including a U.S. resident alien).
The Internal Revenue Service does not require your consent to any provision of this contract other than the certifications required to avoid backup withholding.

If you wish to apply for a loan as well, please note this in the Special Instructions/Comments field and the Credit Union will contact you. There is no need for you to fill out a seperate loan application as long as you include this information. cms_form_captcha ">

Security Code:

Security Code

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