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Personal
Eligibility
Finish

What are you applying for?

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*
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
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

Almost done! Let’s wrap up a few more items

Branch Region
Promo Code

Eligibility


Almost there!
Let’s wrap up the last couple of items

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


What is the source of deposits into your account (select all that apply)
Bank Draft
Employment Income
Gift
Grants
Internal Tranfer
Investment Income
Loans
Retirement/Pension income
Trust
Other
Will you process any ACH transactions?
Will you process any wires?


 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.
First Name* Last Name*
Member Number/SSN* Date of Birth*
Phone* Email*
–

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Savings
  
Checking
  
Certificate
  

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