Membership Application

Please print and complete the application below and mail it to Atlantic Federal Credit Union, 37 Market St., Kenilworth, N.J. 07033. Enclose a $25 check or money order as your initial deposit and copies of ID. One should be a government-issued photo ID (driver’s license, passport, county ID card) and a copy of a recent paystub to validate employment eligibility. Please be sure to fill out the eligibility section below.

Important Information About Opening A New Account

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account.

New members (including joint owners) must provide a copy of a government-issued ID (driver’s license, passport or county ID card).

Share/Savings Account

Name_____________________________

Soc Sec No._________________________

Street________________________

City_________________ State____ Zip________

Home Phone Number______________________

Date of Birth_____________________________

Driver's Lic. #__________________________ State Issued_____

Email Address__________________________

Mother's Maiden Name___________________

Place of Employment_____________________

Business Phone_________________________

Employer Address______________________

City______________ State______ Zip_____

Eligibility (choose the appropriate section):

____ I am eligible for membership in AFCU because I work for a member company

Company Name________________________________

Company Address_____________________________

Company Phone_______________________________

____ I am eligible for membership in AFCU because I am a family member of an existing member.

Member's Name________________________________

Member’s Account Number________________________________

Member's Signature________________________

Relationship___________________________________

____ I am eligible for membership because I (check one)_____ live, ____work,______workship, _____volunteer, _______ attend school or ____ regularly do business in the city of Newark.

Name and address of qualifying activity checked above:_______________________________________________

____________________________________________________

 

Ownership Type (check one):

___ Individual  ___ Joint Member  ___ Custodian for minor  ___ Revocable Trust

___ Payable on Death (List Name & Address of Beneficiary Below)

__________________________________________________________


Joint Member Name________________________

Soc Sec No.__________________

Street_______________________________

City____________ State_____ Zip________

Home Phone Number________________________

Date of Birth____________________

Member Signature & Date_______________________________________________

Joint Member Signature & Date__________________________________________

Send me the Credit Union's FREE periodic Electronic Newsletter that contains fast breaking credit union news and advance notice of special credit union promotions.
Yes____ No____

Checking Account

Account Number___________________

Soc Sec No_____________________

Name_____________________________

Date of Birth____________________

Driver's Lic. #_________________________

State Issued__________________________

Joint Member Name (if desired)____________________________________

Soc Sec No.________________________________

Street_____________________________________

Phone__________________

City________________________ State______ Zip_______

Member Signature & Date____________________________________________

Joint Member Signature & Date____________________________________________

VISA®Check Card/ATM Card

Please Check One:  ____ ATM Card ____ VISA®Check Card

Account Number__________________________

Member Name____________________________

Phone No._______________________

Joint Member Name_______________________

Mother's Maiden Name_______________

Address __________________________

City____________ State____ Zip________

Do you want a card in joint owner's name?  _____yes  _____no

To apply for an Atlantic FCU VISA®Check Card, you must have an Atlantic Federal CU Checking Account. If you would like 24-hour ATM Access and do not have an Atlantic Federal CU Checking Account, your application will be processed for an Atlantic Federal CU ATM Card.

Member Signature & Date__________________________________________________

Joint Member Signature & Date____________________________________________