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Membership Application
NOTE: Before filling out this Membership Application, please make sure that you are eligible for Membership.

This is the first step to becoming a member of NW Priority CU.
Once we receive this application we will send you a
Signature Card that you will need to sign.

HOW TO USE THIS FORM

  1. Print out this page
  2. Fill out all pertinent information
  3. Include a minimum deposit of $25.00
  4. We will need photo copies of acceptable photo ID* of all owners on the account
  5. Mail to:
NW Priority CU
PO Box 16640
Portland OR 97292-0640

Need Help?
(503) 760-5304 or 800-331-0968
staff@nwprioritycu.org

Membership Eligibility

Employment

Family Name _____________________ Account # _____________ Relation ______________

Ownership

Individual Joint with Right of Survivorship

Primary Owner

Last Name ______________________________________________________________

First Name _____________________________________ MI _________

Physical Address _________________________________________________________

________________________________________________________________________

Mailing Address (if different) _______________________________________________

________________________________________________________________________

Employer _______________________________________________________________

Social Security Number ______ - ___ - _________

Date of Birth _______________________________

Home Phone _______________________________

Work Phone _______________________________

Mother's Maiden Name ______________________

Joint Owner

Last Name ______________________________________________________________

First Name ___________________________________ MI _________

Address ________________________________________________________________

_______________________________________________________________________

Social Security Number _____ - ___ - ________

Date of Birth ____________________________

Home Phone ____________________________

Work Phone ____________________________

Mother's Maiden Name ___________________

Joint Owner

Last Name ______________________________________________________________

First Name _____________________________________ MI ______________

Address ________________________________________________________________

Social Security Number ______ - ___ - _________

Date of Birth _______________________________

Home Phone _______________________________

Work Phone _______________________________

Mother's Maiden Name ______________________

Account Desired Savings Sharedraft/Checking

USA PATRIOT ACT

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask your name, address (both mailing and physical), date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

Acceptable Forms of Identification

  • Government Issued Driver's License (with photo)
  • Government Issued Identification Card (with photo)
  • Military Identification (with photo)
  • Employer Issued Identification (with photo)
  • School Issued Identification (with photo)
  • Passport (with photo)

By signing below, I/We authorize NW Priority CU to obtain a credit report to verify my/our eligibility for accounts and services.

Signatures

_____________________________________ _________________
Primary Owner Date
_____________________________________ _________________
Joint Owner Date
_____________________________________ _________________
Joint Owner Date