Light Commerce CU family in front of house

Church Application

Home > Applications > Church Application

Business Application for Membership

* Required Fields

Primary Applicant

Business Name:

TIN:

Street Address:

Street Address 2:

City:

State:

ZIP:

Mailing Address:

Mailing Address 2:

City:

State:

ZIP:

Office Phone:

Email Address:

NLCCC Membership Number:

Authorized Signers on the Account

Name (Last First Middle):

Social Security Number:

- -

Date of BIrth:

/ /

Driver;s License #:

State:

Street Address:

Street Address 2:

City:

State:

ZIP:

Home Phone:

Work Phone:

Cell:

Email Address:

Name (Last First Middle):

Social Security Number:

- -

Date of BIrth:

/ /

Driver;s License #:

State:

Street Address:

Street Address 2:

City:

State:

ZIP:

Home Phone:

Work Phone:

Cell:

Email Address:

TIN CERTIFICATION AND BACKUP WITHHOLDING

By signing below, I certify, in accordance with the IRS W-9 instructions provided by the Credit Union and under penalties of perjury, that the Social Security Number (SSN/Taxpayer Identification Number (TIN) shown is my/the correct identification number and that I am NOT, unless designated below, subject to backup withholding because I have not been notified that I am subject to backup withholding and I am a U.S. Person (including a U.S. Resident alien).

Furthermore, by signing below, I agree to the terms and conditions of the Membership and Account Agreement, Truth in Savings Rate and Fee Schedule, Funds Availability Policy Disclosure and to any amendment the Credit Union makes from time to time which are incorporated herein. I acknowledge receipt of the Agreement and Disclosures applicable to the accounts and services requested. If an ATM or EFT service is requested and provided, I agree to the terms of and acknowledge receipt of the Electronic Funds Transfer Agreement.

I CERTIFY:

I am subject to backup withholding

Exempt

I am not a U.S. citizen or resident (complete W-8 form)

AUTHORIZATION

The Internal Revenue Service does not require consent to any provision of this document other than the certifications required to avoid backup withholding.

Security Code:

PHYSICAL ADDRESS

1535 Greensmark Drive

Houston, TX 77067

Mailing Address

P.O. Box 670494

Houston, TX 77267

HOURS

Monday-Friday

10:00 AM - 4:00 PM

Facebook Instagram

User ID:
Password:

Church Application

Business Application for Membership

PHYSICAL ADDRESS

Mailing Address

HOURS

FOLLOW US