NuMark Credit Union Membership Application

Membership Application

To qualify for membership in NuMark Credit Union, one must live or work in the geographical area defined by our regulator or be employed at one of the 260 employee groups associated with NCU. To see if you qualify for membership, contact NuMark at (815)729-3211.

I would like to apply for membership in NuMark Credit Union. I understand that upon submission of this application, I will receive a Membership Agreement and Member Identity Information & Verification Card in the mail to complete, sign and return.

Date/Time

Owner Name

Driver's License #

Owner's SSN#

Owner's Birth Date

Joint Owner

Joint Owner's Driver's License #

Joint Owner's SSN#

Joint Owner's Birth Date

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone

Business Phone

Employer

Position

Mother's Maiden Name

Important Information About Procedures for Opening a New Account

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. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your valid driver''s license or other identifying documents.

By transmitting this form, I/we are requesting membership in NuMark Credit Union. Upon approval of membership, I/we agree to the terms, conditions and disclosure which I/we will receive and return with my/our initial deposit. I/We authorize the credit union to verify credit and employment history by any necessary means including preparation of a credit report by a credit reporting agency.