To simplify the process of registering for an account, we offer this web based form that you can fill out now and print. If you would prefer to download the form as a Word document, you may do so by clicking here.

  527 Stephenson Avenue, Suite 2
      Savannah, GA 31405
      Phone: (912) 356-9225
      Fax: (912) 356-9226
      workmenscirclecu.com

Account Card

ACCOUNT TYPE
All of the terms, conditions, form of account ownership, account selection and other information indicated on this Card apply to all of the accounts listed unless the Credit Union is notified in writing of a change.
 
Share / Savings
Share Certificate / Certificate

Money Market
Other:
 
TIN CERTIFICATION AND BACKUP WITHHOLDING INFORMATION

Under penalties of perjury, I certify that:
(1) The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued),
(2) I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
(3) I am a U.S. person (including a U.S. resident alien).
Certification Instructions.  Cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.  Cross out item 3 and complete a W-8 BEN if you are not a U.S. person.
MEMBER APPLICATION AND OWNERSHIP INFORMATION
Member
Street
City / State / Zip
Phone Home
Phone Work
    Account No.
    SSN / TIN
    Driver's Lic No.
    Date of Birth
    Email
Employment
Eligibility for Membership


 
AUTHORIZATION

By signing below, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Disclosure, Funds Availability Policy Disclosure, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein.  I/We acknowledge receipt of a copy of the Agreement and Disclosures applicable to the accounts and services requested herein. If an access card or EFT service is requests and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Fund Transfers Agreement and Disclosure. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
 
X_____________________________________
       Signature                                                   Date

X_____________________________________
       Signature                                                   Date
 X_____________________________________
       Signature                                                   Date

X_____________________________________
       Signature                                                   Date
©CUNA Mutual Group, 1993, 96, 2000, 01, 04, 07, ALL RIGHTS RESERVED

D1100(2)
TO ORDER 1-800-356-5012

 

ACCOUNT SERVICES

Payroll Deduction / Direct Deposit
PC Access/Internet Branching

Other EFT Service:
Other:
 
ACCOUNT OWNERSHIP

Designate the ownership of the accounts for the services requested.
 

Single Party           Multiple Party with Survivorship             Multiple Party without Survivorship
 
MEMBER APPLICATION AND OWNERSHIP INFORMATION
Joint Owner   SSN / TIN
Street   Driver's Lic. No.
City / State / Zip   Date of Birth
Phone Home Work Email
Joint Owner   SSN / TIN
Street   Driver's Lic. No.
City / State / Zip   Date of Birth
Phone Home Work Email
 
ACCOUNT DESIGNATIONS

Payable on Death (POD) / Trust Account

Beneficiary
Street
City / State / Zip

 

Beneficiary
Street
City / State / Zip
   
UTTMA / UGMA (as custodian for (minor) under the Uniform Transfers / Gifts to Minor's Act) Minor's TIN / SSN
Other See Account Authorization Card
 

FOR CREDIT UNION USE         See Account Change Card   See Insurance Beneficiary Card
Date of Membership_____________ Opened / App'd by ____________ Member Verification___________
PIN Request Credit Report  Check Verify  Access Card Internet Branching