Membership Application

Referral Code (optional)

I/We authorize Mill Town Credit Union to open the following accounts:
	Share (Savings) - Required		Certificate of Deposit
	Checking		Christmas Club

Owner Information
Last Name	First Name	MI

SSN	Date of Birth (mm/dd/yyyy)	Mother's Maiden Name

Address (Do not use P.O. Box)

City	State	Zip Code

Email Address

Home Phone	Cell Phone
() -Second partThird part	() -Second partThird part
Work Phone	Ext. #
() -Second partThird part
Photo ID Type	Issue Date of ID (mm/dd/yyyy)	Expiration Date of ID (mm/dd/yyyy)

ID #	State of Issuance

Owner Employment Info
Employed By	Employer Address	Occupation

Membership Eligibility
If you are eligible through a family member, please tell us the name of the Mill Town Credit Union member and their relation to you:
Our membership is open to anyone who works, lives, worships or goes to school in the following school districts in the State of Washington.
Name of Member	Relationship

Joint Owner Information
Last Name	First Name	MI

SSN	Date of Birth (mm/dd/yyyy)

Address (Do not use P.O. Box)

City	State	Zip Code

Email Address

Home Phone	Cell Phone
() -Second partThird part	() -Second partThird part
Work Phone	Ext. #
() -Second partThird part
Photo ID Type	Issue Date of ID (mm/dd/yyyy)	Expiration Date of ID (mm/dd/yyyy)

ID #	State of Issuance

Joint Employment Info
Employed By	Employer Address

Beneficiaries
Beneficiary Name	SSN	Phone
Upon death of the last surviving account holder, the balance in this account shall be paid to:
		() -Second partThird part
Address

City	State	Zip


Beneficiary Name	SSN	Phone
		() -Second partThird part
Address

City	State	Zip

Mill Town Credit Union Can Help Save You Money!
Tell me how Mill Town Credit Union can help me save money on my existing auto loan with another lender Tell me how Mill Town Credit Union can help me save money on refinancing my current mortgage Tell me how Mill Town Credit Union can help me lower my credit card payments and/or interest rate

Electronic Submission
Being within the field of membership, I/we hereby apply for membership in the Mill Town Credit Union and agree to conform to its bylaws and amendments thereto; subscribe for at least one share; and agree to the conditions printed in this form.
By clicking submit below, I/we agree to be bound by the Mill Town Credit union's bylaws, and all rules, regulations, terms and conditions governing this account, and all amendments thereto which may be in effect from time to time. I have read and accept the Membership Agreement and Disclosures. Mill Town Credit Union is hereby authorized to recognize any of the signatures subscribed hereto in the payment of funds or the transaction of any business for this account. I/We authorize you to obtain information about me/us from credit reporting sources, and report my/our experience with this account to credit bureaus and others who may inquire about my/our experience with this account. You may also request or use subsequent consumer reports in connection with a review, update, renewal or extension of my/our accounts without additional notice to me/us.

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.

Prior to submitting this application, please enter the security code in the box below