By signing below, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Rate and Fee Schedule, and to any amendment the Credit Union makes form 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.

Under penalties of perjury, I certify (1) that the number shown on this form is my correct taxpayer identification number and (2) that I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service (IRS) has notified me that I am no longer subject to backup withholding.

(Notice: If you have been notified by the Internal Revenue Service (IRS) that you are subject to backup withholding and you have not received a notice from the IRS advising you that the backup withholding has terminated, please mark through statement No. 2 in the paragraph above. If backup withholding applies to you, the Credit Union is required by the IRS to withhold 31 percent of interest, dividends and other payments made to your starting on January, 1993.)

The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholdings.