Ben

efi

ciary

Desig

natio

n – P

ayab

le o

n D

eath

All living joint owners/m

embers on Account supersede beneficiaries.

Beneficiary/Payee

Social Security N

umber

Address

City

State Zip Code

Date of Birth

Beneficiary/Payee

Social Security N

umber

Address

City

State Zip Code

Date of Birth

•I hereby apply for m

embership at CAP CO

M FCU. I agree to conform

to its laws and am

endments thereof and subscribe for at least one share. I also agree to the term

s and conditions of any account that I have at the Credit Union, now

or in the future and agree that the terms and conditions m

ay change from tim

e to time.

•Statutory Lien N

otice – Except as otherwise provided by federal law

, CAP COM

FCU has the right to impress and enforce a statutory lien against a m

ember’s shares and

dividends in the event the mem

ber fails to satisfy a financial obligation to the Credit Union. The Credit Union has the authority to enforce this statutory lien right without

further notice to the mem

ber. A mem

ber’s financial obligations include, but are not limited to, outstanding loan balances, N

SF (insufficient funds) checks and related fees.•

If more than one beneficiary is nam

ed, proceeds will be equally distributed. The nam

ed beneficiaries can only be changed by written authorization signed by all account

owners.

•M

y signature below is evidence that everything stated is correct to the best of m

y knowledge. M

y signature also authorizes CAP COM

FCU to obtain a consumer credit

report in connection with this process and for any update, renew

al, or extension of credit received; and at my request, the Credit Union w

ill supply me w

ith the name and

address of any credit bureau from w

hich it will receive, or has received, a consum

er report on me. I am

aware that com

pletion of this mem

bership application is not to be considered as an application for credit.

•Agreem

ent: CAP COM

FCU is hereby authorized to recognize any of the signatures subscribed hereto in the payment of funds or the transaction of any business for this

account. The joint owners of this account hereby agree w

ith each other and with CAP CO

M FCU that all sum

s now paid in on shares, or heretofore or hereafter paid on

shares by any or all of the joint owners to their credit as such joint ow

ners with all accum

ulation thereon, are and shall be owned by them

jointly, with the right of

survivorship and be subject to the withdraw

al or receipt of any of them, and paym

ent to any of them or the survivor or survivors shall be valid and discharge CAP CO

M

FCU from any liability for such paym

ent.•

You have read the agreement for each service for w

hich you have applied. By signing below you acknow

ledge receipt and agree to be bound by the terms of the

agreement for each service checked on the front of this application.

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

ithholding.

Under penalties of perjury, I certify: (1) that the num

ber shown on this form

is my correct Taxpayer Identification num

ber, (2) that I am N

OT subject

to backup withholding (either because I have not been notified that I am

subject to backup withholding as a result of failure to report all interest or

dividends, or the Internal Revenue Service has notified me that I am

no longer subject to backup withholding); and (3) that I am

a U.S. person (including a U.S. Resident A

lien).

Youth’s Nam

e/Signature: Joint O

wner’s N

ame:

Join

t Ow

ner’s Sig

natu

re: (m

ust be notarized or witnessed by a CAP CO

M Em

ployee)(N

ote: any future products or services established on this account are the responsibility of all parties. We require a youth’s account to be opened w

ith a joint owner at least 18

years of age.) TO

OPEN

/CH

AN

GE A

N A

CC

OU

NT, A

T CA

P CO

M FC

U, Y

OU

R SIG

NA

TUR

E MU

ST BE N

OTA

RIZED

:The above signature w

as notarized in the State of ________________County of ___________________this ____Day of ___________, Year ________. Before m

e personally came to m

e known and know

n to me to be the individual described in and w

ho executed the attached instrument, and he/she duly

acknowledged that he/she executed the sam

e.N

OTA

RY PU

BLIC

:

TO O

PEN/C

HA

NG

E AN

AC

CO

UN

T, AT C

AP C

OM

FCU

, YO

UR

SIGN

ATU

RE M

UST B

E NO

TAR

IZED:

The above signature was notarized in the State of ________________County of ___________________this ____Day of ___________, Year ________.

Before me personally cam

e to me know

n and known to m

e to be the individual described in and who executed the attached instrum

ent, and he/she duly acknow

ledged that he/she executed the same.

NO

TARY

PUB

LIC:

Offi

ce Use O

nly

Credit pulled O

FAC PreApp

TIS Disc Chex ID copied

Approved Date

Account Num

ber

Phone Numbers & Website CCFCU Phone (518) 458-2195 CCFCU Toll Free (800) 468-5500 CCFCU Fax (518) 458-2261 Touch-24 (518) 458-8986 Touch-24 Toll Free (800) 634-2340 Connect-24 & Mobile Banking www.capcomfcu.org

Main Office & Mailing Address 18ComputerDriveEast•Albany,NY12205

Already a CAP COM Member? Enroll in our School Banking Program! Call (518) 458-2195, send an e-mail to schoolbanking@capcomfcu.org or stop in any location and tell us your participating school’s name.

Not a CAP COM Member? It’s easy to get a School Banker started with a new YouthAccount! •CompleteaYouthMembershipApplication. •Call(518)458-2195orsendane-mailto schoolbanking@capcomfcu.org. •Visitwww.capcomfcu.org. •Askatanybranchlocation.

Albany • Brunswick • Clifton Park Cohoes • Colonie • Glenmont • Glens Falls

Latham • Niskayuna • North Greenbush

REV 9/2011

CAP COM FCU is federally insured by the National Credit Union Administration.

Mortgage Solutions

www.capcomfcu.orgTo sign up your school

call Carie Sala today at (518) 458-2195 ext. 3671 or send an e-mail to csala@capcomfcu.org.

I hav

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clud

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e of

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ativ

e___

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ives

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ks, w

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ips

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ttend

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e St

ate

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ail A

ddre

ss

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othe

r’s m

aide

n na

me

or w

ord

to b

e us

ed a

s a“

lock

war

ning

/sec

urity

” co

de

T-Sh

irt S

ize (C

ircle

onl

y on

e):

Yout

h: S

M

L

Adu

lt: S

Jo

int

Mem

ber

(Mus

t be

at

leas

t 18

yea

rs o

ld.)

I

hav

e in

clud

ed a

cop

y of

a v

alid

ID. A

Join

t Mem

ber i

s an

indi

vidu

al w

ho h

as:

est

ablis

hed

mem

bers

hip

with

CAP

CO

M F

CU a

nd, i

f qua

lified

, is

elig

ible

for a

ll pr

oduc

ts a

nd s

ervi

ces.

elig

ibili

ty:

em

ploy

er

rela

tive

(nam

e)

(re

latio

nshi

p)

liv

es, w

orks

, wor

ship

s or

atte

nds

scho

ol in

the

Stat

e of

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k, C

ity o

f: (p

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ny

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es

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nsse

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Sc

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ctad

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W

ater

vlie

t To

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of G

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nd La

st N

ame

Firs

t Nam

e

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iddl

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ame

Addr

ess

City

St

ate

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ip C

ode

O

wn

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ent

Liv

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ith o

ther

s H

ow lo

ng?

Soci

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ecu

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mb

er

Dat

e o

f B

irth

Hom

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one

Num

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Wor

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one

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ver’

s Li

cen

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um

ber

*

Stat

e*

Is

sue

Dat

e*

Ex

pir

atio

n D

ate*

E-m

ail A

ddre

ss:

Empl

oyer

Nam

e

Empl

oyer

Add

ress

Ci

ty

St

ate

Zip

Code

I aut

horiz

e CA

P CO

M F

CU to

est

ablis

h or

add

the

follo

win

g ac

coun

ts/s

ervi

ces:

H

olid

ay C

lub

M

embe

rs C

hoice

Clu

b

Mon

ey M

anag

ers

Club

C

olle

ge S

avin

gs C

lub

N

ame

your

ow

n clu

b

Yout

h M

embe

rshi

p A

pplic

atio

n

Plea

se c

ompl

ete

both

pag

es

Page

1 o

f 2

REV

9/20

11

*Req

uire

d to

pro

cess

app

licat

ion.

$chool BankingBecome a School Banking

partner today!

We’re teaching kids at dozens of local schools how to save!

Madison and Jeffrey Clermont, of Watervliet Elementary.

School Banking helps kids learn to save by making deposits at school. We partner with more than 40 local schools to offer special visits, online account access and more!

It’s easy to get started! Complete the attached application or see the back panel to learn how to open up an account or sign your school up today!

School Banking features

• Switch Kits to get you started. We’ll transfer and close your old account for you!

• Kids earn up to $70 per year* with our Great Grades and Reading Programs.

• Special-rate CertifiKIDs** in 18- and 36-month terms let your child’s money grow faster!

• Open an account with just $1. Make weekly deposits at your school or any CAP COM location! The more you save, the more you can win with fun incentives.

• FREE Coin Machines! Turn change into cash at any CAP COM branch!

*See website or ask an associate for additional details, current rates and disclosure information. ** Certificate requires membership in the Credit Union. Certificate dividends are compounded daily and posted quarterly. A penalty may be imposed for early withdrawals. Fees and other conditions may reduce the earnings on some accounts. Other rates and terms may apply based on product/service relationship with the Credit Union.

Ben

efi

ciary

Desig

natio

n – P

ayab

le o

n D

eath

All living joint owners/m

embers on Account supersede beneficiaries.

Beneficiary/Payee

Social Security N

umber

Address

City

State Zip Code

Date of Birth

Beneficiary/Payee

Social Security N

umber

Address

City

State Zip Code

Date of Birth

•I hereby apply for m

embership at CAP CO

M FCU. I agree to conform

to its laws and am

endments thereof and subscribe for at least one share. I also agree to the term

s and conditions of any account that I have at the Credit Union, now

or in the future and agree that the terms and conditions m

ay change from tim

e to time.

•Statutory Lien N

otice – Except as otherwise provided by federal law

, CAP COM

FCU has the right to impress and enforce a statutory lien against a m

ember’s shares and

dividends in the event the mem

ber fails to satisfy a financial obligation to the Credit Union. The Credit Union has the authority to enforce this statutory lien right without

further notice to the mem

ber. A mem

ber’s financial obligations include, but are not limited to, outstanding loan balances, N

SF (insufficient funds) checks and related fees.•

If more than one beneficiary is nam

ed, proceeds will be equally distributed. The nam

ed beneficiaries can only be changed by written authorization signed by all account

owners.

•M

y signature below is evidence that everything stated is correct to the best of m

y knowledge. M

y signature also authorizes CAP COM

FCU to obtain a consumer credit

report in connection with this process and for any update, renew

al, or extension of credit received; and at my request, the Credit Union w

ill supply me w

ith the name and

address of any credit bureau from w

hich it will receive, or has received, a consum

er report on me. I am

aware that com

pletion of this mem

bership application is not to be considered as an application for credit.

•Agreem

ent: CAP COM

FCU is hereby authorized to recognize any of the signatures subscribed hereto in the payment of funds or the transaction of any business for this

account. The joint owners of this account hereby agree w

ith each other and with CAP CO

M FCU that all sum

s now paid in on shares, or heretofore or hereafter paid on

shares by any or all of the joint owners to their credit as such joint ow

ners with all accum

ulation thereon, are and shall be owned by them

jointly, with the right of

survivorship and be subject to the withdraw

al or receipt of any of them, and paym

ent to any of them or the survivor or survivors shall be valid and discharge CAP CO

M

FCU from any liability for such paym

ent.•

You have read the agreement for each service for w

hich you have applied. By signing below you acknow

ledge receipt and agree to be bound by the terms of the

agreement for each service checked on the front of this application.

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

ithholding.

Under penalties of perjury, I certify: (1) that the num

ber shown on this form

is my correct Taxpayer Identification num

ber, (2) that I am N

OT subject

to backup withholding (either because I have not been notified that I am

subject to backup withholding as a result of failure to report all interest or

dividends, or the Internal Revenue Service has notified me that I am

no longer subject to backup withholding); and (3) that I am

a U.S. person (including a U.S. Resident A

lien).

Youth’s Nam

e/Signature: Joint O

wner’s N

ame:

Join

t Ow

ner’s Sig

natu

re: (m

ust be notarized or witnessed by a CAP CO

M Em

ployee)(N

ote: any future products or services established on this account are the responsibility of all parties. We require a youth’s account to be opened w

ith a joint owner at least 18

years of age.) TO

OPEN

/CH

AN

GE A

N A

CC

OU

NT, A

T CA

P CO

M FC

U, Y

OU

R SIG

NA

TUR

E MU

ST BE N

OTA

RIZED

:The above signature w

as notarized in the State of ________________County of ___________________this ____Day of ___________, Year ________. Before m

e personally came to m

e known and know

n to me to be the individual described in and w

ho executed the attached instrument, and he/she duly

acknowledged that he/she executed the sam

e.N

OTA

RY PU

BLIC

:

TO O

PEN/C

HA

NG

E AN

AC

CO

UN

T, AT C

AP C

OM

FCU

, YO

UR

SIGN

ATU

RE M

UST B

E NO

TAR

IZED:

The above signature was notarized in the State of ________________County of ___________________this ____Day of ___________, Year ________.

Before me personally cam

e to me know

n and known to m

e to be the individual described in and who executed the attached instrum

ent, and he/she duly acknow

ledged that he/she executed the same.

NO

TARY

PUB

LIC:

Offi

ce Use O

nly

Credit pulled O

FAC PreApp

TIS Disc Chex ID copied

Approved Date

Account Num

ber

Phone Numbers & Website CCFCU Phone (518) 458-2195 CCFCU Toll Free (800) 468-5500 CCFCU Fax (518) 458-2261 Touch-24 (518) 458-8986 Touch-24 Toll Free (800) 634-2340 Connect-24 & Mobile Banking www.capcomfcu.org

Main Office & Mailing Address 18ComputerDriveEast•Albany,NY12205

Already a CAP COM Member? Enroll in our School Banking Program! Call (518) 458-2195, send an e-mail to schoolbanking@capcomfcu.org or stop in any location and tell us your participating school’s name.

Not a CAP COM Member? It’s easy to get a School Banker started with a new YouthAccount! •CompleteaYouthMembershipApplication. •Call(518)458-2195orsendane-mailto schoolbanking@capcomfcu.org. •Visitwww.capcomfcu.org. •Askatanybranchlocation.

Albany • Brunswick • Clifton Park Cohoes • Colonie • Glenmont • Glens Falls

Latham • Niskayuna • North Greenbush

REV 9/2011

CAP COM FCU is federally insured by the National Credit Union Administration.

Mortgage Solutions

www.capcomfcu.orgTo sign up your school

call Carie Sala today at (518) 458-2195 ext. 3671 or send an e-mail to csala@capcomfcu.org.

I have included my $1 initial deposit. Eligibility School Banking Program at: (school name) Grade Or Employer Relative Name of Relative_______________________________ Relationship__________________________ Or Lives, works, worships or attends school in the State of New York, City of: (please circle one) Albany Cohoes Mechanicville Rensselaer Schenectady Troy Watervliet Town of Green Island

Last Name First Name Middle Name

Address City State Zip Code

Social Security Number Date of Birth

Home Phone Number

E-mail Address Mother’s maiden name or word to be used as a“lock warning/security” code

T-Shirt Size (Circle only one): Youth: S M L Adult: S

Joint Member (Must be at least 18 years old.) I have included a copy of a valid ID. A Joint Member is an individual who has: established membership with CAP COM FCU and, if qualified, is eligible for all products and services. eligibility: employer relative (name) (relationship) lives, works, worships or attends school in the State of New York, City of: (please circle one) Albany Cohoes Mechanicville Rensselaer Schenectady Troy Watervliet Town of Green Island Last Name First Name Middle Name

Address City State Zip Code

Own Rent Live with others How long?

Social Security Number Date of Birth

Home Phone Number Work Phone Number

Driver’s License Number* State* Issue Date* Expiration Date*

E-mail Address:

Employer Name

Employer Address City State Zip Code

I authorize CAP COM FCU to establish or add the following accounts/services: Holiday Club Members Choice Club Money Managers Club College Savings Club Name your own club

Youth Membership Application

Please complete both pages Page 1 of 2

REV 9/2011

*Required to process application.

$ch

oo

l Ban

kin

gB

ecom

e a Sch

oo

l Ban

kin

g p

artner to

day

!

We’re teach

ing k

ids at d

ozen

s o

f local sch

oo

ls ho

w to

save!

Madison and Jeffrey C

lermont,

of Watervliet Elem

entary.

Scho

ol B

ankin

g helps kids learn to save by

making deposits at school. W

e partner with

more than 40 local schools to offer special

visits, online account access and more!

It’s easy to get started! Com

plete the attached application or see the back panel to learn how

to open up an account or sign your school up today!

Sch

oo

l Ban

kin

g features

•Sw

itch K

its to get you started. We’ll

transfer and close your old account for you!

•K

ids earn

up

to $70 p

er year* with

our Great G

rades and Reading Programs.

•Special-rate C

ertifiK

IDs** in 18- and

36-month term

s let your child’s money

grow faster!

•O

pen

an acco

un

t with

just $1.

Make w

eekly deposits at your school or any C

AP C

OM

location! The more you

save, the more you can w

in with

fun incentives.

•FR

EE Co

in M

achin

es! Turn change into cash at any C

AP C

OM

branch!*See w

ebsite or ask an associate for additional details, current rates and disclosure inform

ation. ** C

ertificate requires mem

bership in the Credit U

nion. Certificate

dividends are compounded daily and posted quarterly. A

penalty m

ay be imposed for early w

ithdrawals. Fees and other conditions

may reduce the earnings on som

e accounts. Other rates and term

s m

ay apply based on product/service relationship with the C

redit U

nion.

Beneficiary Designation – Payable on DeathAll living joint owners/members on Account supersede beneficiaries.

Beneficiary/Payee Social Security Number

Address City State Zip Code Date of Birth

Beneficiary/Payee Social Security Number

Address City State Zip Code Date of Birth

• I hereby apply for membership at CAP COM FCU. I agree to conform to its laws and amendments thereof and subscribe for at least one share. I also agree to the terms and conditions of any account that I have at the Credit Union, now or in the future and agree that the terms and conditions may change from time to time.

• Statutory Lien Notice – Except as otherwise provided by federal law, CAP COM FCU has the right to impress and enforce a statutory lien against a member’s shares and dividends in the event the member fails to satisfy a financial obligation to the Credit Union. The Credit Union has the authority to enforce this statutory lien right without further notice to the member. A member’s financial obligations include, but are not limited to, outstanding loan balances, NSF (insufficient funds) checks and related fees.

• If more than one beneficiary is named, proceeds will be equally distributed. The named beneficiaries can only be changed by written authorization signed by all account owners.

• My signature below is evidence that everything stated is correct to the best of my knowledge. My signature also authorizes CAP COM FCU to obtain a consumer credit report in connection with this process and for any update, renewal, or extension of credit received; and at my request, the Credit Union will supply me with the name and address of any credit bureau from which it will receive, or has received, a consumer report on me. I am aware that completion of this membership application is not to be considered as an application for credit.

• Agreement: CAP COM FCU is hereby authorized to recognize any of the signatures subscribed hereto in the payment of funds or the transaction of any business for this account. The joint owners of this account hereby agree with each other and with CAP COM FCU that all sums now paid in on shares, or heretofore or hereafter paid on shares by any or all of the joint owners to their credit as such joint owners with all accumulation thereon, are and shall be owned by them jointly, with the right of survivorship and be subject to the withdrawal or receipt of any of them, and payment to any of them or the survivor or survivors shall be valid and discharge CAP COM FCU from any liability for such payment.

• You have read the agreement for each service for which you have applied. By signing below you acknowledge receipt and agree to be bound by the terms of the agreement for each service checked on the front of this application.

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

Under penalties of perjury, I certify: (1) that the number shown on this form is my correct Taxpayer Identification number, (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 failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding); and (3) that I am a U.S. person (including a U.S. Resident Alien).

Youth’s Name/Signature: Joint Owner’s Name:

Joint Owner’s Signature: (must be notarized or witnessed by a CAP COM Employee)(Note: any future products or services established on this account are the responsibility of all parties. We require a youth’s account to be opened with a joint owner at least 18 years of age.) TO OPEN/CHANGE AN ACCOUNT, AT CAP COM FCU, YOUR SIGNATURE MUST BE NOTARIZED:The above signature was notarized in the State of ________________County of ___________________this ____Day of ___________, Year ________. Before me personally came to me known and known to me to be the individual described in and who executed the attached instrument, and he/she duly acknowledged that he/she executed the same.NOTARY PUBLIC:

TO OPEN/CHANGE AN ACCOUNT, AT CAP COM FCU, YOUR SIGNATURE MUST BE NOTARIZED:The above signature was notarized in the State of ________________County of ___________________this ____Day of ___________, Year ________. Before me personally came to me known and known to me to be the individual described in and who executed the attached instrument, and he/she duly acknowledged that he/she executed the same.NOTARY PUBLIC:

Office Use OnlyCredit pulled OFAC PreApp TIS Disc Chex ID copied Approved Date Account Number

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CC

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sen

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tell

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new

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