Floodwood CU - Applications

Please provide all the requested information. When you have completed the form, press the Submit button to send your application. Your request will be processed within two to four business days.

Required fields are marked with an *

Savings Account Type

Individual Account Joint Account

Other (explain)

Applicant Information	Co-Applicant Information
Full Name*	Full Name
Address*	Address
City*	City
State/Province*	State/Province
ZIP/Postal Code*	ZIP/Postal Code
Country*	Country
Social Security Number*	Social Security Number
Mother's Maiden Name
Home Phone*	Home Phone
Work Phone
Best Time to Call Weekdays Weekends
Home E-mail Work E-mail
Drivers License Number Drivers License State

Acknowledgements
Credit Report Information that the financial institution obtain credit reports on me/us from time to time. I/We understand that the financial institution will use the credit reports in evaluating my/our credit worthiness for various credit products offered by the institution.
Certification and Agreement (1) The number(s) shown in this application is/are the correct taxpayer identification number(s) and I/we am/are not subject to backup withholding either because I/we have not been notified that I/we am/are subject to backup withholding as a result of failure to report all interest or dividends, or the IRS has notified me/us that I/we am/are no longer subject to backup withholding. (2) by the IRS that I/we am/are subject to backup withholding due to notified payee underreporting and I/we have been notified that the backup withholding is terminated. (3) I / We agree to be bound by the provisions of the applicable disclosure(s) for products I/we have selected.This financial institution will furnish such applicable disclosure(s) to me/us within the timeframe(s) prescribed by regulation and I/we will inform this financial institution if I/we do not receive full disclosure(s).