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Are you currently a member of UICCU?

Yes

Member, please allow us to verify your account information.

Member Number (also known as your Account Number) *

Name (Last, First, M.I.) * Social Security Number *

NONRESIDENT ALIENS AND FOREIGN INDIVIDUALS

Are you a U.S. citizen? Members

Yes

What is your country of origin (home country or country of citizenship)?

Do you have a Green Card, or are you a foreign resident of the U.S. (legal permanent resident)? Members

Yes

Do you have citizenship with any other country? Members

Yes

With what countries do you have citizenship?

Do you travel outside of the state more than once per month? Members

Yes

Do you travel outside of the U.S.? Members

Yes

To which countries do you travel?

Date of Birth * Primary Phone Number * Mother’s Maiden Name * Email Address * Residential Address * City * State *

- Choose a State -

Zip Code * Mailing Address (if different from your Residential Address) Mailing City Mailing State

- Choose a State -

Mailing Zip Code

How can we assist you? Select all that apply.

Open a new deposit product with my existing account.Member

Which deposit products are you interested in? Select all that apply.

CheckingMember

Which checking account are you interested in? Rewards Checking (Learn More)Member R2 Checking (Learn More)Member Free Checking (Learn More)Member Access Checking (Learn More)Member Please select which free services you are interested in for your checking account: Online BankingMember Bill PayerMember Debit CardMember e-StatementsMember Direct DepositMember

The following questions are required by law and will not impact how you can use your account, but rather assist us in protecting you from fraudulent activity.

Will the initial deposit exceed $5,000? Members

Yes

What is the source of funds for this initial deposit?

- Choose a Source -

Will you deposit or write checks? Members

Yes

Will you be using mobile/remote deposit capture to deposit your checks? Members

Yes

Will you deposit or withdraw cash? Members

Yes

Approximately how much cash do you expect to deposit each month?

- Choose an Amount -

Approximately how much cash do you expect to withdraw each month?

- Choose an Amount -

Will you send or receive wire transactions? Members

Yes

What is the expected monthly total of wire transactions that you expect to send?

- Choose an Amount -

What is the expected monthly total of wire transactions that you expect to receive?

- Choose an Amount -

Will these wires be sent to or received from non-U.S. locations? Members

Yes

Which countries will you receive wire transfers from? UICCU does not send wire transfers outside of the U.S.

Will you send or receive electronic transactions (such as sending bill payments or receiving direct deposits?) Members

Yes

What is the expected monthly total of electronic transactions that you expect to send?

- Choose an Amount -

What is the expected monthly total of electronic transactions that you expect to receive?

- Choose an Amount -

Will these electronic transactions be sent to or received from non-U.S. locations? Members

Yes

Which countries will you send electronic transactions to or receive from?

Certificate of Deposit (Learn More)Member

CD: Which term (in months) are you interested in? CD Term Months

Click here to view our current rates and terms.
($500 minimum to open/$1,000 minimum on specials)

Individual Retirement Account (Learn More)Member

Which type of IRA are you interested in? TraditionalMember RothMember IRA: Which term (in months) are you interested in? IRA Term Months

Click here to view current rates and terms.

Money Market (Learn More)Member

Which type of Money Market are you interested in? Premier Money Market Mega Money Market

Click here to view our current rates.

Savings (Learn More)Member

Add a joint member to my existing account (this member will be joint on all current and future deposit products within this member number with the exception of IRA's)

Please provide Joint Member's information

Joint Member Name (Last, First, M.I.) * Joint Member Social Security Number * Joint Member Date of Birth * Joint Member Primary Phone Number * Joint Member Mother’s Maiden Name * Joint Member Email Address * Joint Member Driver’s License Number * Joint Member Driver's License State *

- Choose a State -

Joint Member Residential Address * Joint Member City * Joint Member State *

- Choose a State -

Joint Member Zip Code * Joint Member Present Employer Name * Joint Member Employer Phone Number * Joint Member Job Title * Joint Member Annual Income *

Add a beneficiary to my account (this member will be joint on all current and future deposit products within this member number with the exception of IRAs)

Please provide Beneficiary's information

Beneficiary Name (Last, First, M.I.) * Beneficiary Social Security Number * Beneficiary Date of Birth * Beneficiary Primary Phone Number * Beneficiary Email Address * Beneficiary Residential Address * Beneficiary City * Beneficiary State *

- Choose a State -

Beneficiary Zip Code * Beneficiary Relationship to Applicant*

Member other questions

Other

Please explain how we can assist you.

Signatures *

In order to activate your account, we need your signature as well as a signature from any joint member (if applicable) submitted with this form. * I would like to sign my documents electronically (via e-mail)

I will stop by a branch to sign:

- Choose a Branch - Member

Mail it to me. Note: Documents and Photo ID must be notarized if you choose this option.

Please review our customer identification policy before submitting membership application. *

Thank you for using our website application. By placing this Web request, you certify that all statements made are true and complete. You authorize the credit union to obtain any information necessary to process this request, including a credit report. A credit union representative will contact you when your request is approved or if any additional information is needed. *

Additional Comments Member

How do you qualify for membership? * I live or work in Iowa or one of these 4 Illinois Counties: Henry, Knox, Mercer, or Rock Island. I am an alumni of the University of Iowa I am related to a current member (provide member number) Known member

For non-members, please complete the following:

Name (Last, First, M.I.) * Social Security Number *

NONRESIDENT ALIENS AND FOREIGN INDIVIDUALS

Are you a U.S. citizen? Non-Members

Yes

What is your country of origin (home country or country of citizenship)?

Do you have a Green Card, or are you a foreign resident of the U.S. (legal permanent resident)? Non-Members

Yes

Do you have citizenship with any other country? Non-Members

Yes

With what countries do you have citizenship?

Do you travel outside of the state more than once per month? Non-Members

Yes

Do you travel outside of the U.S.? Non-Members

Yes

To which countries do you travel?

Date of Birth * Primary Phone Number * Mother’s Maiden Name * Email Address * Driver’s License Number * Driver's License State *

- Choose a State -

Residential Address * City * State *

- Choose a State -

Zip Code *

Residence Type *

Rent Own

Mailing Address (if different from your Residential Address) Mailing City Mailing State

- Choose a State -

Mailing Zip Code

Present Employer Name * Employer Phone Number * Job Title * Annual Income *

How can we assist you? Select all that apply

Open a new account

Which deposit products are you interested in? Select all that apply.

Checking

Which checking account are you interested in? Rewards Checking (Learn More) R2 Checking (Learn More) Free Checking (Learn More) Access Checking (Learn More) Please select which free services you are interested in for your checking account: Online Banking Bill Payer Debit Card e-Statements Direct Deposit

The following questions are required by law and will not impact how you can use your account, but rather assist us in protecting you from fraudulent activity.

Will the initial deposit exceed $5,000? Non-Members

Yes

What is the source of funds for this initial deposit?

- Choose a Source -

Will you deposit or write checks? Non-Members

Yes

Will you be using mobile/remote deposit capture to deposit your checks? Non-Members

Yes

Will you deposit or withdraw cash? Non-Members

Yes

Approximately how much cash do you expect to deposit each month? Non-Members

- Choose an Amount -

Approximately how much cash do you expect to withdraw each month? Non-members

- Choose an Amount -

Will you send or receive wire transactions? Non-Members

Yes

What is the expected monthly total of wire transactions that you expect to send? Non-members

- Choose an Amount -

What is the expected monthly total of wire transactions that you expect to receive? Non-members

- Choose an Amount -

Will these wires be sent to or received from non-U.S. locations? Non-Members

Yes

Which countries will you receive wire transfers from? UICCU does not send wire transfers outside of the U.S. Non-members

Will you send or receive electronic transactions (such as sending bill payments or receiving direct deposits?) Non-Members

Yes

What is the expected monthly total of electronic transactions that you expect to send? Non-members

- Choose an Amount -

What is the expected monthly total of electronic transactions that you expect to receive? non-members

- Choose an Amount -

Will these electronic transactions be sent to or received from non-U.S. locations? Non-Members

Yes

Which countries will you send electronic transactions to or receive from? Non-member

Certificate of Deposit (Learn More)

CD: Which term (in months) are you interested in? Non-Member CD interest Months

Click here to view our current rates and terms.
($500 minimum to open/$1,000 minimum on specials)

Individual Retirement Account (Learn More)

Which type of IRA are you interested in? Traditional Roth IRA: Which term (in months) are you interested in? Non-Member IRA interest Months

Click here to view current rates and terms.

Money Market (Learn More)

Which type of Money Market are you interested in? Premier Money MarketNon-Member Mega Money MarketNon-Member

Click here to view current rates and terms.

Savings (To become a member, you must open a savings account with at least $5.00. Learn More)

Add a joint member to my account (this member will be joint on all current and future deposit products within this member number with the exception of IRA's)

For non-members, please provide Joint Member's information

Joint Member Name (Last, First, M.I.) Joint Member Social Security Number * Joint Member Date of Birth * Joint Member Primary Phone Number * Joint Member Mother’s Maiden Name * Joint Member Email Address * Joint Member Driver’s License Number * Joint Member Driver's License State *

- Choose a State -

Joint Member Residential Address * Joint Member City * Joint Member State *

- Choose a State -

Joint Member Zip Code * Joint Member Present Employer Name * Joint Member Employer Phone Number * Joint Member Job Title * Joint Member Annual Income *

Add a beneficiary to my account (this member will be joint on all current and future deposit products within this member number with the exception of IRA's)

Please provide Beneficiary's information

Non-member beneficiary Beneficiary Name (Last, First, M.I.) * Beneficiary Social Security Number * Beneficiary Date of Birth * Beneficiary Primary Phone Number * Beneficiary Email Address * Beneficiary Residential Address * Beneficiary City * Beneficiary State *

- Choose a State -

Beneficiary Zip Code * Beneficiary Relationship to Applicant*

Non-member other and how can we help you? Other

Please explain how we can assist you.

References *

Reference 1

Reference 1 Name (Last, First, M.I.) * Reference 1 Residential Address * Reference 1 City * Reference 1 State *

- Choose a State -

Reference 1 Zip Code * Reference 1 Primary Phone Number *

Reference 2

Reference 2 Name (Last, First, M.I.) * Reference 2 Residential Address * Reference 2 City * Reference 2 State *

- Choose a State -

Reference 2 Zip Code * Reference 2 Primary Phone Number *

Signatures *

Non-member signatures In order to activate your account, we need your signature as well as a signature from any joint member (if applicable) submitted with this form. * I would like to sign my documents electronically (via e-mail)

I will stop by a branch to sign:

- Choose a Branch - Non-Member

Mail it to me. Note: Documents and Photo ID must be notarized if you choose this option.

Please review our customer identification policy before submitting membership application. *

Additional Comments Non-member

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