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T ALERIS CREDIT UNION, INC. MEMBERSHIP APPLICA TION 
1.	Qualification for Membership | WE CANNOT PROCESS YOUR APPLICATION WITHOUT THE REQUIRED PROOF OF ELIGIBILITY
TO BE ELIGIBLE FOR MEMBERSHIP, YOU MUST LIVE, WORK, ATTEND SCHOOL OR WORSHIP IN CUYAHOGA, MEDINA, LORAIN, LAKE, SUMMIT, GEAUGA, PORTAGE, WAYNE, ASHTABULA, COLUMBIANA, MAHONING, ASHLAND, TRUMBULL OR STARK COUNTY OR, WORK FOR A TALERIS CORPORATE PARTNER, OR BE A RELATIVE OF A CURRENT TALERIS MEMBER, OR JOIN A PARTICIPATING ASSOCIATION.
A complete listing of Taleris Corporate Partners and participating associations can be found at www.taleriscu.org/partners+associations/
VALID IDENTIFICATION INCLUDES: a valid Ohio Driver’s license or State ID. If you are eligible because of where you work, attend school or worship, include a recent pay stub, or a school schedule, or a donation envelope or letter from your place of worship. Family Referral Letters are available at www.taleriscu.org/ applications or call 800.828.6446. Association membership requires an additional, one time $5.00 fee added to your initial deposit.

CHECK ONLY ONE: | New Application | Update |
| | Membership Number | Date

Live

Work

Attend School

Worship

Cuyahoga	Medina	Lorain	Lake	Summit	Geauga	Portage	Stark
Ashtabula	Ashland	Trumbull	Wayne	Mahoning	Columbiana

Work for Taleris Corporate Partner (Enter company name. Include recent pay stub)
Relative of current Taleris Member (Enter Member Name. Include Family Referral Letter)
Join Association (requires additional $5 added to initial deposit)	Public Animal Welfare Society	Seven Hills Historical Society

CHECK ONE	IF YOU CHECKED LIVE, WORK, ATTEND SCHOOL, OR WORSHIP—CHECK TO INDICATE YOUR COUNTY

2.	Enclose Initial Deposit to open account (Association Members require an additional $5.00 in initial deposit to cover Association Fee)
AN INITIAL DEPOSIT MUST BE INCLUDED WITH THIS APPLICATION. Minimum deposit is $5.00 — check or money order Payable to: Taleris CU is preferred.
DO NOT SEND CASH. NOTE: If you are eligible because of Association Membership, include the $5 Assoc. Fee with your initial deposit (can be totaled on one check).

Initial Deposit Amount 		Check	Money Order	Other  	

3.	Choose account type (For Account Type descriptions, see the Account Types form available at www.taleriscu.org/applications or call 800.828.6446. For Accounts with Beneficiaries, please fill out the Beneficiary Information Form available at www.taleriscu.org/applications or by calling 800.828.6446)
Individual - No Beneficiary	Individual - With Beneficiary: Payable On Death (POD) Account	Joint with Right
(Fill out Beneficiary Information Form)	of Survivorship

4.	Enter your Personal Information

 	PRIMARY MEMBER - FILL OUT COMPLETELY	

 	JOINT OWNER - FILL OUT COMPLETELY	

First Name

Initial

Last Name

First Name

Initial

Last Name

Street Address

Apt.#

Street Address

Apt.#

PO Box

City

PO Box

City

State

Zip

Home Phone

State

Zip

Home Phone

Work Phone (and area code)

Cell Phone (and area code)

Work Phone (and area code)

Cell Phone (and area code)

SSN/TIN#

Mother’s Maiden Name

SSN/TIN#

Mother’s Maiden Name

ID# (Driver’s License or Approved ID)

State of Issue	Exp. Date (mm/dd/yyyy)

ID# (Driver’s License or Approved ID)

State of Issue	Exp. Date (mm/dd/yyyy)

Date of Birth (mm/dd/yyyy)

Own Home? Yes/ No

Date of Birth (mm/dd/yyyy)

Own Home? Yes/ No

Current Employer

Occupation

Current Employer

Occupation

E-mail Address

E-mail Address

BEST WAY TO REACH ME DURING NORMAL BUSINESS HOURS:

BEST WAY TO REACH ME DURING NORMAL BUSINESS HOURS:

Home Phone

Work Phone

Cell Phone

Email

Home Phone

Work Phone

Cell Phone

Email

continued on next side

5.	
No ATM/Debit Card

Account Options:
No Checks
with my checking account

Choose accounts
Primary Savings (required for membership)

Classic Checking (Interest Bearing)	Basic Checking (No Monthly Fee)
requires direct deposit into checking
I am also interested in learning more about:

Auto Loans | Home Equity Loans | Mortgage Loans | Personal Loans | Bill Consolidation Loans
Money Market | IRA’s | Holiday Savings Acct. | Online Bill Pay | Term Share Certificate
Direct Deposit | Payroll Deduction | E-Statements | Business Services |

6.	Declaration For the Primary member Check appropriate statement(s) in this section, sign and date.
I AM A U. S. PERSON Includes U.S. Citizen, U.S. Resident Alien, Partnership Corporation, company or corporation created or organized in the United States or under the laws of the United States, an estate (other than a foreign estate) or a domestic trust.
Under penalty of perjury, I certify: (1) The number shown on this form is my correct taxpayer ID number (or I am waiting for a number to be issued to me), and (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 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).
I am NOT a U.S. Person.	(Complete IRS Form W8BEN) I am subject to backup withholding.
The Internal Revenue service does not require your consent to any provisions of this document other than the certifications required to avoid backup withholding.

Signature of Primary Member	Date

7.	Sign application
I/we hereby make application for membership in Taleris Credit Union (TCU) and agree to conform to its articles, bylaws and regulations, and to subscribe for at least one
(1) share. I/we agree to be bound by the applicable agreements which have been provided to me/us in current form for the accounts and services listed herein. All accounts designated to have one or more co-owners in addition to the Primary Member shall be in Joint and Survivorship form.

Note: All accounts are insured to $250,000 by ASI (American Share Insurance), a private member owned insurer. This institution is not federally insured, and if the institution fails, the Federal Government does not guarantee that depositors will get back their money. MEMBERS’ ACCOUNTS ARE NOT INSURED OR GUARANTEED BY ANY GOVERNMENT OR GOVERNMENT SPONSORED AGENCY.
By signing below, I/we certify that the information on this application is complete, true and submitted for the purpose of obtaining the accounts and services requested. I/we agree that for the purpose of: (a) verifying information on this application or (b) extending credit or services to me/us or (c) reviewing or collecting my/our credit accounts, Taleris Credit Union may, at any time, utilize a credit reporting agency to obtain my/our credit report and/or verify my/our employment.
I understand that this application must be completed in its entirety for Taleris to process my/our request.

CHECK HERE IF THERE ARE ADDITIONAL JOINT OWNERS LISTED ON THE SEPARATE JOINT MEMBER INFORMATION FORM

Signature of Primary Member	Date

Signature of Joint Owner (if applicable)

8.	How Did You Hear About Us?
Work For  	

Family or Friend	Previous Member	Branch Banner

Radio Ad	Print Ad	TV Ad	Online	Other (please specify below)

FOR OFFICE USE ONLY: SEG #   	

Mail To:
Taleris Credit Union, Inc. | ATTENTION: Member Services
P.O. BOX 318072
Cleveland, OH  44131-8072

R

YOUR SAVINGS INSURED TO $250,000 PER ACCOUNT. This institution is not federally insured, and if the institution fails, the Federal Government does not guarantee that depositors will get back theirmoney.

OPPORTUNITY

MEMBERS’ACCOUNTS ARE NOT INSURED OR GUARANTEED BY ANY GOVERNMENT OR GOVERNMENT-SPONSORED AGENCY.	^EQUAL ^HOUSING

MD0.060	08/19/19