Membership Application

We keep info you provide confidential. We do not trade or sell addresses, phone #s, etc.

Account #		SIGNATURE CARD (CFFCU use only above this line)		Other/old CFFCU Acct. #'s
PRINT FULL LEGAL NAME (as on your picture ID):				U.S. SOCIAL SECURITY OR TAX ID #
RESIDENCE ADDRESS			CITY		STATE	ZIP
MAILING ADDRESS			CITY		STATE	ZIP
PHONE NUMBERS INCLUDING AREA CODE :work, home, cell, pager, fax , e-mail:
DATE OF BIRTH	State & Driver's License or ID #
I apply for membership in Calif. Feminist Fed'l Credit Union; agree to conform to Bylaws and any amendments thereto; am not subject to Backup Withholding due to failure to report interest/dividend income; certify under penalties of perjury that Taxpayer ID/Social Sec. # and other info provided on this form are true, correct, and complete; I am a U.S. person (includes resident alien of the USA). Signature X___________________________________ Date Signed____________________
Affiliation/Eligibility (CFFCU use only below this line)					Date Opened	By (initials)
CFFCU Membership Officer's Signature						Date Approved

2. Eligible to join us? (See Easy to Join) If so, check 1 or more boxes below; enter $0

[] a. I am the (check one): []parent []child []sister []brother of current CFFCU member (name

[] c. I used to have a CFFCU account (name and # if known):______________________

3. Dues/Contribution Amount $________________________(list here AND under 4c) TO:__________________________________________(Qualifying Organization's name)

4. Breakdown of Amount Enclosed: (please do not send cash)
a. $___$9.00_fee to open

+ +b. $___________opening deposit: $50 to open, over $50 in cleared checks (most are held

14-21 days) before withdrawing. Bring balance up to $250 within 6 months to prevent June 30 & December 31 low-balance fees;

+c. $___________ dues or contribution from #3 above ($0 if you qualify under #2)

+d. $___________ education fund (optional) supports talks, "how-to" pamphlets, worksheets, etc.

Total $_________*Make one check or money order payable to CFFCU; if you checked #3,

5. What shall we send* to you? How? [ ] e-mail [ ] by post [ ] fax #______________

[] I'll be signing up for an electronic deposit to my Cal Feminist account by payroll deduction. I'll need a form to sign that includes your ABA or routing number. I

understand that, in order to protect my privacy, you will not e-mail or fax my new savings account # to me. I understand, too, that you do not permit anyone to make electronic withdrawals from Cal Feminist savings accounts. Please:

(check one) [ ] wait for me to call you for my savings account # [ ] mail it to me

[] Savings Simplifier info (find out how you can have up to 9 different Cal Feminist

accounts, all appearing on one statement, to save for different goals, such as

[] Savings Simplifier Account Forms. How many accounts would you like to open?______

[] Info Sheet: what types of accounts can I open for others, such as children and other

[X] The temporary Signature Card I printed out from your Web site is enclosed; send me a

b. Loan App (check one or more) []pre-approval [] purchase []payoff or refinance

[] Engine Equity (home + car = possible tax deduction. No appraisal! Ask for details)

c. Loan Rates for types of loans checked under "Loan App." above (or, click on Loans)

[] Health Insurance flyer (for Cal Feminist members in most states) includes:

[] Health Insurance "Grid" for Californians: summarizes--and provides contact info for-- alternative plans available through other sources, including plans for those with pre-existing conditions; low-income (including those who qualify for Medi-Cal as well as those who receive too much income to qualify for Medi-Cal); plans for those whose incomes are low but have assets that disqualify them from access to government-subsidized programs; coverage for children; coverage for pregnant women.

[] Prescriptions Available at reduced rates (for members in all states and D.C. ): info sheet

[] Dental Plan Option for CFFCU members residing in California Includes a list of questions you can ask to help you select the dental plan that's best for your needs.

[] How to Live on Less (4 page article & 2 worksheets: "Spending Plan" & "Setting Goals")

[] Shopping for Mortgage Loans: How to Compare Them; resources for home-buying education

[] Temporary Housing (such as for homeless, victims of domestic violence, seniors)

[] Information about the Irene Mercado Scholarship, available to (1) women who belong to Cal Feminist; (2) the following family members of all Cal Feminist members: daughters, granddaughters, nieces, sisters, mother, grandmothers.

6. To help us comply with the USA Patriot Act, enclose a legible photocopy of one of the following forms of unexpired government-issued photo ID:

7. How�d you learn about us? []word of mouth []yellow pages under Credit Unions

[]someone from your organization spoke at a meeting of (name of group)________________

*Cal Feminist members pay no extra charge for information sheets, worksheets, etc.; they are a benefit of membership.

Usually within about one week of joining, we'll send you items you've checked above. If you need something sooner, let us know.

Usually within about three weeks of joining, we'll send you a Member Handbook along with a Savings Register you can use to track your deposits and withdrawals between statements. (You won't need to request it.)

Send Signature Card, Membership Application, copy of photo I.D., and one or two checks or money orders to:

MEMBERSHIP APPLICATION & SIGNATURE CARD

MEMBERSHIP APPLICATION
& SIGNATURE CARD