APPLICATION FOR "RATE RISER CERTIFICATE"

MINIMUM BALANCE $5,000

Withdrawal of funds before maturity will result in a penalty equal to 90 days dividends.

TYPE: ( ) NEW CERTIFICATE
( ) EXISTING RATE RISER CD/ONE TIME ONLY ADDITIONAL DEPOSIT

DIVIDEND PAYMENT (Select One):
( ) COMPOUNDING….Monthly dividends will accrue and cannot be withdrawn prior to Certificate Maturity.
( ) SIMPLE…….………Monthly dividends will be credited to your Share Savings Account.

CERTIFICATE MATURITY AND ANNUAL PERCENTAGE YIELD (APY):
One Year Term_______%APY

AMOUNT OF CERTIFICATE: $___________________

REGISTERED IN THE FOLLOWING NAME(S)
________________________ ________________________
Share Account # Member Name
_______/_________/_______ ________________________
Social Security Number Phone Number
________________________ _______/_________/_______
Joint Member Social Security Number
________________________ _______/_________/_______
Joint Member Social Security Number
________________________ _______/_________/_______
Beneficiary (POD) Social Security Number
________________________ _______/_________/_______
Beneficiary (POD) Social Security Number



METHOD OF PAYMENT (Select One):
( ) Please transfer funds from my Share(savings) Account for purchase
( ) Attached is my check for purchase (check will be deposited in share account to purchase certificate)

UPON CERTIFICATE MATURITY:
I Understand my certificate will close, and balance will transfer back to my Share Savings.

THE UNDERSIGNED ACKNOWLEDGES RECEIPT OF A COPY OF THE TERMS AND CONDITIONS APPLICABLE , AND POLICY DISCLOSURE.

_________________________________________
Member Signature

_________________________________________
Date

37 Market St., Kenilworth, NJ 07033

Tel: (908) 245-1750 Fax : (908) 245-0680