Secure New Account Application


 

Existing Members: Use this secure form to open a new account.

To add services to an existing account, please select the appropriate item below and complete all request information on the New Account Application.

When complete, please press SUBMIT. To complete the account opening process, please print this completed form, sign and date it and mail it to us with your opening deposit of $5.00 or more.

All fields with an asterisk (*) indicated required fields that must be completed before submitting your application.

* Type of Account
  Individual Account
  Joint Account

 
I would like to open the following account:
 
The minimum opening deposit for all Share Savings and Checking Accounts is $5.00. For all other products, please see below.
  FREE Checking
  Dividend Checking
  Term Certificate (minimum opening deposit $500.00)
Term  
     
  Statement Savings (ATM and Electronic Access available)
  High Yield Savings
  Money Market Savings (minimum opening deposit $1,000.00) Please choose if you would like to receive checks for this account type
   
With Checks
   
Without Checks
  Individual Retirement Account (minimum opening deposit $25.00)
   
Traditional
   
Roth
   
Education
  Christmas Club
  Other Club
* Today's Date
 
Primary Signer Information
* Last Name
* First Name
  Middle Initial
* Residential Address
     Not P.O. Box
* City
* State
* Zip
  Mailing Address
     If different
  City
  State
  Zip
* SS# - -
* Date of Birth (MM/DD/YYYY) / /
* Are You a U.S. Citizen? Yes No
* Mother's Maiden Name
* First School Attended
* Home Phone Number
* Work Phone #
* E-mail Address
 
Secondary Signer
* Last Name
* First Name
  Middle Initial
* Residential Address
     Not P.O. Box
* City
* State
* Zip
  Mailing Address
     If different
  City
  State
  Zip
* SS# - -
* Date of Birth (MM/DD/YYYY) //
* Are You a U.S. Citizen? Yes No
* Mother's Maiden Name
* First School Attended
* Home Phone Number
* Work Phone #
* Email Address
 
Other Services Requested
  Master Money Debit/ATM Card - Checking Accounts Only (primary signer)
  Master Money Debit/ATM Card - Checking Accounts Only (secondary signer)
  ATM Card (primary signer)
  ATM Card (secondary signer)
 
Please check any additional services you are interested in.
We will provide additional information to you via mail:
  Direct Deposit
  Payroll Deduction
  Overdraft Protection - from statement savings account
* Certification
 
Under penalties of perjury, I certify that the number shown on this form is my correct taxpayer identification number and (check one)
 
I am not subject to backup withholding either because (a) I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends or (b) the Internal Revenue Service has notified me that I am no longer subject to backup withholding

 
I have been notified that I am subject to backup withholding.
(The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding
 

IMPORTANT: PLEASE READ THE FOLLOWING BEFORE SIGNING OR SUBMITTING YOUR APPLICATION
  a)
I have read and understand the account disclosures for the products for which I am applying.
  b)
I plan to open the account(s) indicated in the summary at the top of this application.
  c)
If I/we are applying for a Rockland Federal Credit Union Master Money Card, I/We understand that it is not a credit card and that the dollar amount of the transactions and purchases will be deducted from my/our Rockland Federal Credit Union checking account only.
  d)
I have read and understand the contents of this application.
  e)
The information provided to Rockland Federal Credit Union is true to the best of my knowledge and I understand that Rockland Federal Credit Union will obtain clearance through either a national check service or credit bureau agency.
  f)
This application will be retained by Rockland Federal Credit Union whether or not is approved.
  g)
I agree that this account is governed by all applicable Federal Laws and Regulations and the laws of the State of Massachusetts.
 

IMPORTANT: BE SURE TO SIGN BELOW BEFORE MAILING IT TO US.

NEW MEMBERS: PLEASE SEND IN A COPY OF YOUR LICENSE(S) WITH YOUR SIGNED APPLICATION.


Primary Signer  ___________________________________________





Secondary Signer _________________________________________
 
Important Terms and Conditions
(Including Electronic Funds Transfer and Funds Availability)


Term Certificate Truth in Savings Disclosure

Privacy and Security Statement



The information you send to RFCU on this form will be encrypted for your privacy and protection.