Highway Crossroads CU

Join Highway Crossroads CU*

New Member

Existing Member

Resume Application

Social Security # *

Date of Birth *

Member Number*

Application ID

Are you a U.S. Citizen?By selecting Yes, you are confirming that you are a U.S. citizen or legal resident alien with a valid Social Security number.

Yes

No

How do you qualify for membership?

I live or work in one of the following counties (Cape Girardeau, New Madrid, Mississippi, Scott, Stoddard)

I am an active employee or retiree of: Missouri Department of Transportation (Southeast District) Missouri State Highway Patrol (Troop E)

I am an immediate family member of an existing member of Highway Crossroads CU

None of the above

What county do you live or work in? *

Which organization do you belong to? *

Who do we thank for referring you? *

How did you hear about us? *

CANCEL & EXIT CONTINUE

ACCOUNT OWNERSHIP

Are you applying for an individual or joint account? * By selecting Joint, you are confirming that your joint applicant has authorized you to apply for a joint account in both your names.

Individual

Joint

PERSONAL INFORMATION

First Name *

Middle

Last Name *

Suffix

PHYSICAL ADDRESS

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Mailing Address same as Physical Address?*

Yes

No

MAILING ADDRESS

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

CONTACT INFORMATION

Mobile Phone # *

Work Phone #

Extension

Preferred Method of Contact *

Email Address *

Confirm Email Address *

Mobile/Email Consent — * Subsequent use of your information will be in accordance with our privacy notice, which will be emailed to you as part of the application process. Highway Crossroads CU may also use this information to contact you by phone call, email, or text message to assist with the completion of the application process. Highway Crossroads CU will also email you other relevant documents and disclosures for your review after the application process.

IDENTIFICATION

Social Security # *

Date of Birth *

Employer *

Occupation *

IdentificationType *

Identification # *

State *

Issue Date *

Expiration Date *

Branch Issued *

Issue Date *

Expiration Date *

Authorization —* I authorize Highway Crossroads CU to verify all information provided and to obtain additional information regarding my personal financial history from a consumer reporting agency or agencies and/or other financial institutions. I understand that this information will only be used in conjunction with Highway Crossroads CU products and services requested by me and that it will remain in effect for the duration of my association with Highway Crossroads CU.

CANCEL & EXIT PREVIOUS STEP VERIFY IDENTITY

PERSONAL INFORMATION (Joint Applicant)

First Name *

Middle

Last Name *

Suffix

PHYSICAL ADDRESS (Joint Applicant)

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Mailing Address same as Physical Address?*

Yes

No

MAILING ADDRESS (Joint Applicant)

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

CONTACT INFORMATION (Joint Applicant)

Mobile Phone # *

Work Phone #

Extension

Preferred Method of Contact *

Email Address *

Confirm Email Address *

Mobile/Email Consent —* Subsequent use of your information will be in accordance with our privacy notice, which will be emailed to you as part of the application process. Highway Crossroads CU may also use this information to contact you by phone call, email, or text message to assist with the completion of the application process. Highway Crossroads CU will also email you other relevant documents and disclosures for your review after the application process.

IDENTIFICATION (Joint Applicant)

Social Security # *

Date of Birth *

Employer *

Occupation *

IdentificationType *

Identification # *

State *

Issue Date *

Expiration Date *

Branch Issued *

Issue Date *

Expiration Date *

Authorization —* I authorize Highway Crossroads CU to verify all information provided and to obtain additional information regarding my personal financial history from a consumer reporting agency or agencies and/or other financial institutions. I understand that this information will only be used in conjunction with Highway Crossroads CU products and services requested by me and that it will remain in effect for the duration of my association with Highway Crossroads CU.

CANCEL & EXIT PREVIOUS STEP VERIFY IDENTITY

Beneficiary Selection

Please choose one of the following as the beneficiary for your HCCU account. * Payable on Death is the most common selection.

Payable On Death

How many Primary Beneficiaries will there be?*

One

Two

Three

Four

Primary Beneficial Owners (1)

First Name *

Last Name *

Relationship to you? *

Percentage *

Primary Beneficial Owners (2)

First Name *

Last Name *

Relationship to you? *

Percentage *

Primary Beneficial Owners (3)

First Name *

Last Name *

Relationship to you? *

Percentage *

Primary Beneficial Owners (4)

First Name *

Last Name *

Relationship to you? *

Percentage *

Secondary Beneficial Owners (1)

First Name *

Last Name *

Relationship to you? *

Percentage *

Secondary Beneficial Owners (2)

First Name *

Last Name *

Relationship to you? *

Percentage *

Secondary Beneficial Owners (3)

First Name *

Last Name *

Relationship to you? *

Percentage *

Secondary Beneficial Owners (4)

First Name *

Last Name *

Relationship to you? *

Percentage *

Missouri Transfers to Minor Law

MTML Name *

Minors Full Name *

Minors SSN *

Agency

Name of Agent *

Custodian

Custodian for: *

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IDENTITY DOCUMENTATION - UPLOAD

Digital Document Required — Please upload a digital copy of your personal identification type.

Identification Type *

ID (Front) *

ID (Back) *

Profile Page *

Barcode Page *

IDENTITY DOCUMENTATION - UPLOAD (JOINT APPLICANT)

Digital Document Required — Please upload a digital copy of your personal identification type.

Identification Type *

ID (Front) *

ID (Back) *

Profile Page *

Barcode Page *

Information Integrity — * I hereby certify that all information provided within this application is true and correct to the best of my knowledge.

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Now the legal details - The following documents contain important information that you are entitled to receive before you consent to transact business with us. Please carefully read the disclosure and print or download a copy for your files. Acknowledge your consent to the terms by checking the corresponding boxes.

Consent to Electronic Records —* I have read the

Disclosures —* I have read and agree to the Membership and Account Agreement Disclosures and the Truth-In-Savings Disclosure & Schedule of Fees

Additional Disclosures —* I have read the Online Banking Disclosures

Additional Disclosures —* I have read the Mobile Deposit User Agreement Disclosures

Additional Disclosures —* I have read the Online Bill Payment Agreement Disclosures

Under penalties of perjury, I certify that: —*

The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued), and
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
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).
The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

The IRS-required certifications set forth in this section apply to the primary member/owner.

Have you been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return?*

Yes

No

CANCEL & EXIT PREVIOUS STEP CONTINUE

We just need to get your opening deposit.

Applicant Name

Select Account Funding Option *

Note — Account information must match your Name and Address. The minimum deposit for your new account: $100

Routing # *

Account # *

Account Type *

Deposit Amount *

ACH Authorization —* By checking this box, if my application is approved, I sign and agree to authorize Highway Crossroads CU (or its agent) ("Bank") to immediately initate a one-time ACH (or other) debit transaction from the deposit account listed above in the amount specified for credit to the "Deposit Account" held at Highway Crossroads CU. I certify that I am authorized to make this debit transaction from the deposit account. I acknowledge that the origination of ACH transactions to my deposit account must comply with provisions of U.S. Law.

You will be presented a link following the submission of your appliaction to fund your account.

Note — Account information must match your Name and Address.

Account # *

Deposit Amount *

New Accounts > Funds AvailabilityWhen depositing into a new bank account, open less than 30 days, the bank is allowed to hold checks for up to 9 business days before making any funds available to you.

Note — The minimum deposit for your new account is $30

VISIT A BRANCH:Please visit a local branch to deposit money into your new account.
Locations & Hours

New Accounts > Funds AvailabilityWhen depositing into a new bank account, open less than 30 days, the bank is allowed to hold checks for up to 9 business days before making any funds available to you.

Note — The minimum deposit for your new account is $30

MAIL CHECKS TO:Highway Crossroads CU
Attention: Deposit Administration
741 York Drive
Sikeston, MO 63801

CANCEL & EXIT PREVIOUS STEP SUBMIT APPLICATION

APPLICATION REQUIREMENTS

PERSONAL IDENTIFICATION

Step 1 — Get Started

Step 2 — Account Setup

Step 3 — Personal Information

Step 3A — Joint Applicant

Step 4 — Account Designation

Step 5 — Identity Documents

Step 6 — Terms & Conditions

Step 7 — Final Steps