P.O. Box 467, Port Jeff. Sta., NY 11776
Phone: (631) 476-6581 • Fax: (631) 476-3689
Secure Checking Account Sign Up Form
By submitting this application, I am authorizing the staff of LICFCU to request and use reports from credit reporting agencies. They may also ask a reporting agency for other such reports in connection with renewal or continuation of the credit for which I am applying.

Checking, Debit Card, and Overdraft Protection Application
 
Personal Account
Application Date:
Your Email Address:
Applicant:
First Name:
Middle Name or Initial:
Last Name:
Street Address:
City:
State:
 Zip:
Home Phone #:
Joint Applicant:
First Name:
Middle Name or Initial:
Last Name:
Street Address:
City:
State: Zip:
Home Phone #:
The Credit Union is hereby authorized to recognize any of the signatures subscribed on this form hereof in the payment of funds or the transactions of any business for this account. The joint owners of this account hereby agree with each other and with the Credit Union that all sums now paid on shares, or heretofore or hereafter paid on shares by any or all of said joint owners with all accumulations thereon, are and will be owned by them jointly with right of survivorship and be subject to the withdrawal of receipt of any of them, and payment to any of them or the survivors will be valid and will discharge the Credit Union from any liability for such payment.

Debit Card

NO Debit Card requested at this time.
I/We request a Debit Card in conjunction with our checking (share draft) account.

Although the Debit Card includes the VISA symbol, it is not a charge card. This card can be used for purchases wherever VISA is accepted, but the deduction will come from my checking account. This card may also be used for ATM transactions. The fees are disclosed in the Fee Schedule. I understand that I will receive the card disclosure/agreement upon receipt of my card(s), and that my overdraft protection will be assessed when needed to honor a transaction.

This Debit Card Application is subject to approval. I authorize the Credit Union to obtain a credit report if necessary.
My gross monthly income is $ .
Number of Cards .

Overdraft Protection

Yes, Overdraft Protection is requested for $.
No Overdraft Protection

Choice of Overdraft Protection:
Transfer overdraft coverage first from the loan, then from the primary share account.
Transfer overdraft coverage from the primary share only.
Transfer overdraft coverage from the loan only.
Transfer overdraft coverage first from the primary share, then from the loan.

  1. The Credit Union is under no obligation to pay a check that exceeds the fully paid and collected share balance in this Account. The Credit Union may, however, pay such check and transfer shares to this Account in the amount of the resulting overdraft, plus a service charge, from the primary share account from which any of the undersigned is then eligible to withdraw shares.
  2. Except for negligence, the Credit Union is not liable for any action it takes regarding the payment or nonpayment of a check.
  3. Any objection relative to any item shown on a periodic statement of this Account is waived unless made in writing to the Credit Union before the end of 60 days after the statement is mailed.

This Overdraft Protection Loan is subject to approval. I authorized the Credit Union to obtain a credit report if necessary.

My (Our) gross monthly income is $ .

Submit Application