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What are you applying for?

Select a checking product

Order a Debit Card?

Overdraft Protection Opt-In

Tell us about yourself!

First Name*	Middle Name

Last Name*	Suffix

Date of Birth*	SSN*

Email*	Phone*
	-
Contact Method*

Street Address*	Extra Address (apt# etc)

City*	State*

Zipcode*	Mailing Address*

Mail Street*	Mail City*

Mail State*	Mail Zipcode*

Employer*	Occupation?*i

Mother's Maiden*	ID Type*

Issuing State*	ID Number*

ID Issue Date*	ID Expiration Date*

I agree that Park may contact me for (among other purposes) promotions and information on my account using direct dial, prerecorded messages, automatic dialers or through the use of text messages. I have the right to withdraw my consent at any time. Please click here for full description.

Add a trusted contacti

A trusted contact is a person that you identify and who the Credit Union may contact on your behalf in certain circumstances, as an added protection in keeping your accounts safe.

By checking to Add a trusted contact, you authorize Park Federal Credit Union, d/b/a Park Community Credit Union, (“Park”) to communicate with the trusted contact persons listed below and/or to disclose to such person(s) non-public personal information about your accounts, loans, credit cards, and all other financial products and services in any of the following circumstances: if Park is unable to reach you after three attempts; if Park suspects possible financial exploitation; or to ascertain or confirm your current contact information, your health status, or the identity of a new account holder or representative (e.g., legal guardian, executor, trustee, or holder of power of attorney). This Trusted Contact Agreement does not authorize your trusted contact persons to execute any account transactions or otherwise provide orders or instructions with respect to any of your accounts.

Each trusted contact person designated by you must be at least 18 years of age. You can revoke, remove, change or add a trusted contact person by submitting a new Trusted Contact Agreement to Park, which will have the effect of revoking any prior trusted contact person designations. Park will rely upon the designations contained in the most recent Trusted Contact Agreement signed by you until you provide notice of revocation to Park.

By checking to Add a trusted contact, you acknowledge and agree to each of the following. Park reserves the right, in its sole discretion, to reject a Trusted Contact Agreement. By entering into this Trusted Contact Agreement, Park is not voluntarily undertaking a legal duty to contact the trusted contact person(s) designated by you. By offering you the opportunity to participate in the Trusted Contact program, Park is not making any promises representations, or guarantees. The Trusted Contact program is not insurance. Losses resulting from financial exploitation or other misconduct of third parties can occur notwithstanding your designation of a trusted contact person. You are responsible for ensuring that the information for your Trusted Contact is current. You hereby release Park and each of its directors, officers, employees, representatives, and insurers of and from any and all claims, liabilities and obligations that arise out of or in any way relate to the authorizations granted by this Trusted Contact Agreement. You agree to indemnify and hold harmless Park from any and all claims, demands, and losses (including reasonable attorney’s fees, expenses and costs) arising from or in any way relating to the Trusted Contact Program or Park’s failure to contact any person designated as a trusted contact person.

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I am a U.S. Citizen

Add a co-applicant?

co-applicant

First Name*	Middle Name

Last Name*	Suffix

Date of Birth*	SSN*

Email*	Phone*
	-
Contact Method

Street Address*	Extra Address

City*	State*

Zipcode*	Employer*

Occupation*	Mother's Maiden*

ID Type*	Issuing State*

ID Number*	ID Issue Date*

ID Expiration Date*

I agree that Park may contact me for (among other purposes) promotions and information on my account using direct dial, prerecorded messages, automatic dialers or through the use of text messages. I have the right to withdraw my consent at any time. Please click here for full description.

I am a U.S. Citizen

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Branch Region

Promo Code

Eligibility

First Name*	Last Name*

Member Number/SSN*	Date of Birth*

Phone*	Email*
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I would like to add:

Savings

Checking

Certificate

Have you, or a close family member, been a politically exposed person?i	Yes	No
Do you travel outside the US?	Yes	No

	Certification of Taxpayer Identification Number and Backup Withholdings
	Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number, 2. I am not subject to backup withholdings 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 withholdings as a result of failure to report all interest or dividends or c) the IRS has notified me that I am no longer subject to backup withholding, and 3.
	Authorization By signing or otherwise authenticating
	I/we agree to the terms and conditions of the Membership and Account Agreement, Disclosure Packet and to any amendment the Credit Union makes from time to time which are incorporated herein. I/We acknowledge electronic receipt of the agreements and disclosures applicable to the accounts and services requested herein. I/We also agree to maintain a minimum balance of $5.00 in a share account to continue membership with Park Community CU. Please click here for full description.
	USA Patriot Act 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 or creates a new member relationship.

Certificate

Which share to fund the certificate from?

What amount would you like to open the certificate with?

I have a joint on my account that I would like to add to the certificate

What are you applying for?

Tell us about yourself!

Primary Trusted Contact Person

Secondary Trusted Contact Person

co-applicant

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Eligibility

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Information

Tools & Resources

Membership

Bank Education

First Name	Middle Name

Last Name	Relationship

Street Address	Extra Address (apt# etc)

City	State

Zipcode	Primary Phone
	-
Secondary Phone	Email
-

What are you applying for?

Tell us about yourself!

Primary Trusted Contact Person

Secondary Trusted Contact Person

co-applicant

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Eligibility

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Information

Tools & Resources

Membership

Bank Education

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Let's wrap up the last couple of items