Membership Application

24 Hour Audio Response Line (316) 978 3121

My CU Credit Card Information

Membership Application

Membership Application

You must be eligible for membership in order to apply for a new account online. Please check one of the following eligibility and then complete all of the requested information. When you have completed the application, press the submit button to send it to Campus Credit Union.

1)	Wichita State University:
		Faculty	Staff
		Graduate	Student
		Alumni Association	Former Student
		Staff of Affiliated Corporations
		Auxiliary Enterprises
		Contract Service Providers

2)		Employees of Cerebral Palsey Research Foundation
3)		Employees of Heartspring
4)		Employees of Center Industries
5)		Employees or students of the University of Kansas, School of Medicine, Wichita Branch

6)	All Other Kansas Higher Education:
		Faculty	Staff
		Graduate	Student
		Former Student

7)		Immediate Family Member of 1-6
		Retiree of 1-6

8)		Any club or organized group, either on or off campus, who has a tax identification number and is represented by an active Campus Credit Union member.

TIN Certification and Backup Witholding Information

I certify in accordance with the IRS W-9 instructions provided by the Credit Union and under penalties of perjury, that the Social Security Number SSN/Taxpayer Identification Number (TIN) shown is my/the correct identification number and that I am NOT, unless designated below, subject to backup withholding because I have not been notified that I am subject to backup withholding as a result of a failure to report all dividends or interest or because the IRS has notified me that I am no longer subject to backup withholding.

	I am subject to backup withholding		Exempt

	I am not a United States Citizen or Resident (complete W-8 Form)

Ownership:

Individual Account

Joint Account

Savings Only			Savings and Checking
A share/savings account is required to establish membership

Primary Owner Information

Name (F/M/L)	Social Security No.	Phone (A/C)
Email	Drivers License No.	Drivers License State
Address (Do Not Use Post Office Box)	City	State	Zip
Renting Buying	Years	Date of Birth (mm/dd/yyyy)

Joint Owner Information

Name (F/M/L)	Social Security No.	Phone (A/C)
Email	Drivers License No.	Drivers License State
Address (Do Not Use Post Office Box)	City	State	Zip
Renting Buying	Years	Date of Birth (mm/dd/yyyy)

Account Designations (Complete information below if you do not add a joint owner)

Name (F/M/L)
Address
City	State:	Zip	Country

Please check if you are interested in the following services:
	Debit Card	Credit Card	Flex Teller (Internet Banking)
	Line of Credit	Overdraft Protection	Payroll Deduction
	Direct Deposit

Agreement

I (we) apply for membership in this credit union, agree to follow it by-laws and amendments and subscribe for at least one share. This membership agreement applies to the accounts indicated. I (we) authorize Campus Credit Union to obtain consumer credit and Chexsystem reports, and you verify that the information on the application is true and correct.

I (we) further understand that additional personal identification in the form of a Drivers License or State Issued ID is required for customers over 16 years of age.

I (we) understand that Campus Credit Union reserves the right to deny the application at the Credit Union’s discretion.

I (we) understand in accordance with The USA Patriot Act to help prevent fraud, identity theft, and the spread of terrorism that Campus Credit Union may require more information from an individual or legal entity to help establish identity.

Campus Credit Union, 1845 N. Fairmount, Box 65, Wichita, KS 67260-0065
Voice: (316) 978-3666 - Fax: (316) 978-3523
Lobby Hours: M-Th 9:00 a.m. - 4:30 p.m. Drive-Thru: M-F 7:30 a.m. - 5:30 p.m.