Certificate Application

In order to open a new Certificate, you must be an existing North County CU member.

About Our Certificates Certificate Rates

When you have completed this form, please remember to click on the SUBMIT button at the end of the form to send your request. Once we process your request, we will mail you a Verification Form along with applicable Account Terms and Conditions. Please sign and return the Verification Form in the provided self-addressed envelope. NOTE: Access to your new Certificate will only be made available once you return this form.

Primary Account Owner Information

Last Name:

First Name:

Middle Initial:

Membership Savings Account Number:

Social Security Number:

Mother's Maiden Name:

Home Phone:

Work Phone:

Email Address:

Joint Account Owner Name

Complete this section only if Certificate is a joint account.

Note: If the Joint Account Owner is not currently a joint owner on the account from which funds are being transferred, your certificate will be opened in your name only and a joint owner form will be forwarded to you for completion.

Last Name:
First Name:
Middle Initial:
Membership Savings Account Number:
Social Security Number:

Select Survivorship

(please select one)
If issued with a joint owner, a certificate is jointly owned with full rights of survivorship, unless otherwise requested. The member and joint owner of this certificate agree that this certificate and accumulated dividends are subject to withdrawal or receipt or payment to either one of them and the survivor. You agree to discharge North County CU from any liability for such payment.
Joint Owner With Survivorship
Joint Owner Without Survivorship

Certificate Funding Instructions

Date To Open Certificate:

(Example: mm-dd-yyyy)

Certificate Term:

Certificate Amount:

(Example: $2,500 = 2500)

Transfer Funds From: (please select one or more)
Note: Transfers permitted from member/owner's account only.

My Membership Savings

Account Number:

Amount To Transfer: $ (Example: $2,500 = 2500)

My Checking Account

Account Number:

Amount To Transfer: $ (Example: $2,500 = 2500)

My Money Market Account

Account Number:

Amount To Transfer: $ (Example: $2,500 = 2500)

Dividend Options

(please select one):
Re-deposit Into The Certificate Amount
Transfer To My Membership Savings Account
Send A Check To My Address On File

Disposition Of Your Funds

Upon maturity, the Credit Union should (please select one):
Automatically renew the Certificate at current rates.
Transfer the funds to my Membership Savings Account Number:

Click on the SUBMIT button to send us your request.

Have questions?

Last Name:
First Name:
Middle Initial:
Membership Savings Account Number:
Social Security Number:
Mother's Maiden Name:
Home Phone:
Work Phone:
Email Address:

	My Membership Savings
	Account Number:
	Amount To Transfer: $	(Example: $2,500 = 2500)

	My Checking Account
	Account Number:
	Amount To Transfer: $	(Example: $2,500 = 2500)

	My Money Market Account
	Account Number:
	Amount To Transfer: $	(Example: $2,500 = 2500)