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Membership Application

Application Requirements
Applicant Information
Tin Certification
  • * Indicates Required

    Application Requirements


    Are you eligible *
    How did you hear about us? *

    Application Type

    Application Type

    Account Type

    All of the terms, conditions, form of account ownership, account selection and other information indicated on this card apply to all of the accounts listed unless the Credit Union is notified in writing of a change. All accounts require a share/savings account with a minimum $5.00 membership balance.

    Additional Accounts *
  • Applicant Information

    Joint Applicant

  • Tin Certification and Backup Withholding

    Under penalties of perjury, I certify that:

    1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued), 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 a 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. citizen or other U.S. person. For federal tax purposes, you are considered a U.S. person if you are: an individual who is a U.S. citizen or U.S. resident alien; a partnership, corporation, company, or association 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 (as defined in Regulations section 301.7701-7).
    4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

    Certification Instructions.

    Backup Withholding Agreement

    Complete a W-8 BEN if you are not a U.S. person. If a W-8 BEN is completed, your signature does not serve to certify this section.


    The undersigned, being a member of Midwest Members Credit Union (the "Credit Union"), a corporation organized under the Illinois Credit Union Act, does hereby constitute and appoint the Board of Directors of the Credit Union, who are the qualified and acting directors at the time this proxy is used, to vote all the shares now or hereafter owned or held by the undersigned, as the said directors or a majority of them see fit for the purpose of voting on all matters on which voting by proxy is permitted under the Illinois Credit Union Act, or the Bylaws of the Credit Union including, but not limited to, voting for the election of directors of the Credit Union and for proposals for merger or voluntary dissolution at all annual or special meetings of the members of the Credit Union hereafter held from time to time and year to year, until and unless this proxy is cancelled by the undersigned member as provided below. This proxy grants to the proxies the limited authority to act for the undersigned as set forth herein and shall be subject to the limitations set forth in the Illinois Credit Union Act. The undersigned hereby revokes any and all proxies heretofore made by me, and hereby expressly declare that the proxy herein given shall continue to remain in effect until: (i) revoked in writing sent by registered or certified mail, return receipt requested, addressed to the Secretary of the Credit Union at P.O. Box 619, Wood River, IL 62095 or such other address or location to which the offices of the Credit Union may be subsequently moved; (ii) by execution of a new subsequently dated proxy; or (iii) by attendance at a meeting and voting in person.

  • Authorization

    By signing below, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Disclosure, Funds Availability Policy Disclosure, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein. I/We acknowledge receipt of a copy of the agreements and disclosures applicable to the accounts and services requested herein. If an access card or EFT service is requested and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Fund Transfers Agreement and Disclosure. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.