Online Services | Open New Accounts - Individual Members

Please provide all the requested information. Once you have completed the application, press the Submit button. Each application will be checked for verification through BANK CARS. You will need to send a check for at least the minimum required amount for each account. Click here for a list of minimum required amounts by account. If you have any problems or questions, please give us a call at (515) 288-7225 or 1-800-343-1028 or e-mail us at info@affinitycuia.org.

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 for your name, address, 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.

Opening New Accounts - Individual Members

Member Information - Primary Account Owner

Last Name:

First Name:

Member #:

New Accounts Desired
(check all that apply)

Fee Free Share Draft Checking Account

Prestige Share Draft Checking
$500 minimum balance requirement

Overdraft Protection (click here for information)

Visa® Check Card (no charge)

Money Market Account

MasterCard® Credit Card

Certificate of Deposit

Holiday Club Account

Mt. Money Youth Savings Account

Vacation Club

Miscellaneous Shares

Loan

If you have accounts at other financial institutions you wish to close complete our Affinity Express Switch Kit. Affinity Express makes it easy to switch your accounts to Affinity Credit Union. Click here to access the Affinity Express Switch Kit.

* - required fields

Residence Address: *
(not a PO Box)

City: *

State: *

Zip Code: *

Mailing Address:
(if different)

City:

State:

Zip Code:

State:

Home Phone No: *

Work Phone No:

E-Mail Address:

Back-up Withholding:
Under the penalties of perjury, I certify that: 1) The number shown on this form is my correct taxpayer identification number, 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 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. person (including a U.S. resident alien).

I am subject to backup withholding

Am not subject to backup withholding

Current Joint Owner I wish to have the same joint owner listed on my current Affinity accounts.

Last Name:

First Name:

+ Add a Joint Owner

Joint Owner 1

Last Name:

First Name:

Middle Name:

Residence Address:
(not a PO Box)

City:

State:

Zip Code:

Mailing Address:
(if different)

City:

State:

Zip Code:

Social Security No:

Driver's License No:

State:

Home Phone No:

Work Phone No:

Date of Birth:

Relationship to Primary Owner:

Mother's Maiden Name:

+ Add a Joint Owner

Joint Owner 2

Last Name:

First Name:

Middle Name:

Residence Address:
(not a PO Box)

City:

State:

Zip Code:

Mailing Address:
(if different)

City:

State:

Zip Code:

Social Security No:

Driver's License No:

State:

Home Phone No:

Work Phone No:

Date of Birth:

Relationship to Primary Owner:

Mother's Maiden Name:

Account Password

Password: *
If you plan to call our office to transact business or request information about your account(s), you must have an account password established. Account passwords enable credit union staff members to verify your identity over the phone.

By submitting the application, I/we agree to the terms and conditions on any approved account, as amended from time to time; and authorize the Credit Union to verify credit and employment history by any necessary means, including request of a credit report by a credit reporting agency. I/we certify that the information provided on this application is true and correct.

You are about to send information over the Internet.

Online Services | Open New Accounts - Individual Members

Opening New Accounts - Individual Members

Member Information - Primary Account Owner

New Accounts Desired (check all that apply)

+ Add a Joint Owner

Joint Owner 1

+ Add a Joint Owner

Joint Owner 2

Account Password

New Accounts Desired
(check all that apply)