Checking Account Application

Primary Applicant

Personal Information

First Name

M.I.

Last Name

Account #

Don’t have an account number? Please put ‘New Member’

Social Security #

Mother's Maiden Name/Password

Driver's License #

Birthdate

Home Phone #

Email

Present Address

City

State

ZIP Code

Years at this address

For Business Accounts

Business Name

Tax I.D. #

Employer Address

City

State

ZIP Code

Phone #

Position or Title

Joint Applicant

Personal Information

First Name

M.I.

Last Name

Account #

Don’t have an account number? Please put ‘New Member’

Social Security #

Mother's Maiden Name

Driver's License #

Birthdate

Home Phone #

Email

Present Address

City

State

ZIP Code

Years at this address

Employment Information

Account Reference

Account Options

Other Information

User Agreement

Everything that you have stated in this application is correct to the best of your knowledge. The Credit Union is authorized to check your credit, employment history, obtain a credit report and to answer questions about their credit experience with you. You may understand that it may be a federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of the United States Criminal Code.

VISA Check Card: I/We understand that anyone in possession of my/our Check Card may access my/our account through use of the Check Card. I/We agree to use the Check Card according to the rules provided by the Credit Union.

Golden Plains Online Banking: You desire to subscribe to the services. This authorization is in force until revoked by you or us in writing and is subject to the Golden Plains Online Agreement and Disclosure (a current copy of which will be furnished to you) as amended from time to time.

Account Disclosures

View the Account Disclosures