Georgia-Pacific Credit Association

ACCOUNT CARD

ACCOUNT TYPE

o Share/Savings __________________________
o Share Draft/Checking ____________________  o Other _________________________________
o Share Certificate/Certificate ________________ o Other _________________________________

TIN CERTIFICATION AND BACKUP WITHHOLDING INFORMATION

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 as a result of a failure to report all dividends or interest, or because the IRS has notified me that I am no longer subject to backup withholding.

o I am subject to backup withholding
o I am not a United States citizen or resident
o Exempt (complete W-8 form)

MEMBER APPLICATION AND INFORMATION

Member_________________________________________ Account No. ___________________
SSN/TIN________________________________________ Date of Birth____________________
Drivers License (State and Number)__________________________________________________
Mailing Address________________________________________________________________
City___________________________________State____________ Zip Code _______________
Street Address (Required if mailing address is PO Box)
_____________________________________________________________________________
City___________________________________State____________ Zip Code _______________
Home Phone #_______________________                            Cell Phone #_____________________
Work Phone #_______________________        EMail __________________________________
Employer Name_________________________________________________________________
Mother's Maiden Name_____________________________________
Eligibility for Membership _________________________________________________________

AUTHORIZATION

By signing below, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Rate and Fee Schedule, 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 Agreement 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 Funds Transfer Agreement. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

Signature_______________________________________Date____________________________________
Signature_______________________________________Date____________________________________
Signature_______________________________________Date____________________________________
Signature_______________________________________Date____________________________________

ACCOUNT SERVICES

    Home Banking(checking only)

    Audio Response

o Payroll Deduction/Direct Deposit
o ATM Card
o Overdraft Protection (indicate transfer priority )_____________________________________________
o Debit Card
o Other EFT Service
o Other

ACCOUNT OWNERSHIP

Designate the ownership of the accounts and responsibility for the services requested.

o Single Party o Multiple Party and Survivorship o Multiple Party without Survivorship

Primary Member___________________________________ Account No. ___________________
SSN/TIN_______________________________________ Date of Birth____________________
Drivers License (State and Number)_________________________________________________
Mailing Address________________________________________________________________
City___________________________________State____________ Zip Code _______________
Street Address (Required if mailing address is PO Box)
_____________________________________________________________________________
City___________________________________State____________ Zip Code _______________
Home Phone #_______________________                            Cell Phone #_____________________
Work Phone #_______________________        EMail __________________________________
Employer Name_________________________________________________________________
Mother's Maiden Name_____________________________________
Eligibility for Membership ________________________________________________________

Joint Member_____________________________________ Account No. ___________________
SSN/TIN________________________________________ Date of Birth____________________
Drivers License (State and Number)__________________________________________________
Mailing Address________________________________________________________________
City___________________________________State____________ Zip Code _______________
Street Address (Required if mailing address is PO Box)
_____________________________________________________________________________
City___________________________________State____________ Zip Code _______________
Home Phone #_______________________                            Cell Phone #_____________________
Work Phone #_______________________        EMail __________________________________
Employer Name_________________________________________________________________
Mother's Maiden Name_____________________________________
Eligibility for Membership _________________________________________________________

o Other
oSee Account Authorization Card

ACCOUNT DESIGNATIONS

o Payable on Death (POD)/Trust Account
o All Accounts
o Designate specific account(s) _________________________

Beneficiary ______________________________ Beneficiary _______________________________
Street __________________________________ Street ___________________________________
City/State/Zip _____________________________ City/State/Zip _____________________________

o UTTMA/UGMA (as custodian for_______________________________________(minor) under the
Uniform Transfers/Gifts to Minors Act) Minor's TIN/SSN__________________________________

o Agency Name of Agent __________________________________________________________
o All Accounts
o Designate specific account(s)__________________________________________

FOR CREDIT UNION USE ONLY

oSee Account Change Card

Date of Membership ____________ Opened/App'd by ____________ Member Verfication____________

PIN Request _________ Credit Report ____________ Check Verify __________ Access Card _________