New Membership Application

Healthcare Systems Federal Credit Union's New Member Agreement Terms and Conditions

• I have read, understood and agreed to the terms and conditions contained in the eDelivery and eSignature Agreement.
• I have read, understood and agreed to the terms and conditions contained in the Privacy Policy, and Consumer Member Service Agreement.
• I agree to fund my account with the option selected. If I have chosen to use an external transfer to fund my account, I agree to the terms and conditions of the ACH Transfer Authorization Agreement.
• I agree my Social Security Number (or Taxpayer Identification Number) entered is correct,
• I am a U.S. person (including U.S. resident alien),
• I am not subject to backup withholding due to failure to report interest and dividend income (this condition does not apply if I previously informed you that I am subject to backup withholding), and
• I am exempt from Foreign Account Tax Compliance Act (FATCA) reporting.
• I do hereby appoint the members of the Board of Directors of Healthcare Systems FCU, who are the qualified and acting directors at the time this proxy is used, as proxies to vote for the election of directors all the shares of Healthcare Systems FCU now or hereafter owned or held by me as the said directors or majority of them see fit, at all annual or special meetings of the members of Healthcare Systems FCU hereafter held and each adjournment thereof, from time to time and year to year, until and unless this proxy is cancelled by me. I further authorize the said proxies to designate a person or committee to cast the vote or votes for me in such manner and for such candidates as the said proxies shall determine and as permitted by law.
• I understand that one of the credit bureaus will access my credit file and other data sources to authenticate my identity and facilitate the processing of this application for this account only. I understand that I may be asked questions based on the information in my credit file and other databases as part of this process. The Internal Revenue Service does not require your consent to any provisions of this document other than certifications required to avoid backup withholding.