IBMSECU 
IBM Southeast Employees' Credit Union 
P.O. Box 5090, Boca Raton, FL 33431-0890 
561.982.4700  •  800.873.5100  •  www.ibmsecu.org  •  serviceplus@ibmsecu.org 

I WOULD LIKE TO OPEN THE FOLLOWING ACCOUNT: 
Vehicle Loan 
Checking 

Savings 

Credit Card 

Term Loan 

MEMBERSHIP ACCOUNT AND LOAN APPLICATION 

New Application 

Update

Member # 

LAST NAME 

I AM THE PRIMARY MEMBER ACCOUNT OWNER. MY INFORMATION IS AS FOLLOWS: 
MIDDLE 

SOCIAL SECURITY # 

FIRST NAME 

SECURITY PASSWORD 

HOME ADDRESS (must be a street address; P.O. Boxes are not acceptable) 

MAILING ADDRESS 

YRS AT RESIDENCE 

RENT 

OWN 

MONTHLY PAYMENT 
$ 

DRIVER'S LICENSE NUMBER/STATE 

DATE OF BIRTH 

OCCUPATION 

HOME PHONE NUMBER 

CELL PHONE NUMBER 

WORK PHONE NUMBER 

EMAIL ADDRESS 

NAME OF QUALIFYING EMPLOYER, ORGANIZATION, COUNTY, OR FAMILY MEMBER 

WILL THIS BE YOUR PRIMARY BANK ACCOUNT? 

YES 

NO  WHAT IS THE MAIN PURPOSE OF THIS ACCOUNT? 

EMPLOYER'S NAME AND ADDRESS 

DATE OF HIRE 

GROSS MONTHLY SALARY 

ADD THE FOLLOWING JOINT OWNER ON MY ACCOUNT (do not complete if you will be the only owner on the account): 

JOINT OWNER ACCOUNT # 

LAST NAME 

FIRST NAME 

MIDDLE 

SOCIAL SECURITY # 

SECURITY PASSWORD 

HOME ADDRESS (must be a street address; P.O. Boxes are not acceptable) 

Check here if same as primary. 

MAILING ADDRESS 

Check here if same as primary. 

YRS AT RESIDENCE 

RENT 

OWN 

MONTHLY PAYMENT 
$ 

DRIVER'S LICENSE NUMBER/STATE 

DATE OF BIRTH 

OCCUPATION 

RELATIONSHIP TO PRIMARY 

HOME PHONE NUMBER 

CELL PHONE NUMBER 

WORK PHONE NUMBER 

EMAIL ADDRESS 

EMPLOYER'S NAME AND ADDRESS 

DATE OF HIRE 

GROSS MONTHLY SALARY 

SECURITY INTEREST 

THE GRANTING OF THIS SECURITY INTEREST IS A CONDITION FOR THE ISSUANCE OF CREDIT UNDER THIS APPLICATION. 
IF YOUR APPLICATION IS APPROVED, YOU SPECIFICALLY GRANT US A CONSENSUAL SECURITY INTEREST IN ALL INDIVIDUAL AND JOINT ACCOUNTS YOU HAVE WITH US NOW 
AND IN THE FUTURE TO SECURE REPAYMENT OF CREDIT EXTENDED UNDER THIS AGREEMENT. YOU ALSO AGREE THAT WE HAVE SIMILAR STATUTORY LIEN RIGHTS UNDER 
STATE AND/OR FEDERAL LAW. IF YOU ARE IN DEFAULT, WE CAN APPLY YOUR SHARES TO THE AMOUNT YOU OWE. 
Shares and deposits in an Individual Retirement Account or any other account that would lose special tax treatment under state or federal law if given are not subject to this security interest. 
If you have other loans with us, collateral securing such loans will also secure your obligations under this Agreement, unless that other collateral is your principal residence or non-purchase money 
household goods. Monies owed prior to death will continue to encumber your shares, deposits and collateral, after your death, suspending the rights of any joint owners or beneficiaries. 

(Applicant Initials) 

(Co-Applicant Initials) 

FOR CREDIT UNION USE ONLY: 

Verification obtained verbally by each applicant 

AUTHORIZED SIGNATURES 
By signing below, I am applying for Membership in the Credit Union and/or for the accounts and services indicated. I certify that all information provided in this Application, including on the 
following pages, is true and complete to the best of my knowledge. I agree to abide by the Bylaws and other rules of the Credit Union and agree not to cause any loss to the Credit Union. I 
acknowledge  receipt  of,  and  agree  to  the  terms  of,  the  Membership  Account  Agreement,  Privacy  Notice,  Funds  Availability  Disclosure,  Electronic  Funds  Disclosure,  Truth-in-Savings 
Disclosures and Rates and Fees Schedule, and Visa Disclosures and to any amendments made thereto. This agreement, and all subsequent amendments and addendums, will be governed 
by applicable Federal law and the laws of the State of Florida. 
Bylaw Requirements: I must complete payment of the following as a condition of admission to Membership: One (1) $5.00 share in my Membership account. If the balance in the account falls 
below what is required for Membership, I may be terminated from Membership immediately, and forfeit any and all Membership rights and privileges. 
Credit Report Authorization. By signing this Application, I authorize you to obtain my credit report for the purposes of evaluating this application and to obtain subsequent credit reports on an 
on- going basis in connection with this transaction, and for all other legitimate purposes, such as reviewing my accounts or taking collection action on the account. 
Vermont Residents: Applicant provided consent via phone  _______________ (Credit Union Initials) 
Permission to contact: By providing a wireless telephone number (i.e., cell phone), I consent to receiving calls, including autodialed and prerecorded message calls, from the credit union or 
its third party providers at that number, such as its fraud prevention monitoring vendor. By providing an email address, I also consent to receiving emails from the Credit Union and its non-
affiliated third-party providers regarding products and services. 
This signature allows the Credit Union to use a facsimile signature on this and future applications. This signature also authorizes the issuance of the Passwords used to access the Telephone 
and Online Banking systems. Using my User Name and Password to access Online Banking will also be considered my authorized signature, to process certain transactions and account 
maintenance, including additional account openings. 
IMPORTANT NOTICE ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT 
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each 
person who opens an account. This means that when you open an account, we will ask for your name, residential address, date of birth, and other information that will allow us to identify you. 
We will also ask to see your driver's license or other identifying information. 
A  LEGIBLE  COPY  OF  ONE  FORM  OF  UNEXPIRED  GOVERNMENT  ISSUED  PHOTO  ID  MAY BE  REQUIRED  FOR  EACH  PRIMARY  MEMBER  AND  JOINT  ACCOUNT  OWNER. 
THE INTERNAL REVENUE SERVICE (IRS) DOES NOT REQUIRE MY CONSENT TOANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION REQUIRED TOAVOID BACKUP WITHHOLDING. 

SIGNATURE OF PRIMARY MEMBER ACCOUNT OWNER (Do Not Print) 
X 

DATE 

SIGNATURE OF JOINT ACCOUNT OWNER (Do Not Print) 
X 

DATE 

IF YOU HAVE ADDITIONAL JOINT OWNERS, PLEASE ATTACH A SEPARATE SHEET WITH THE REQUESTED INFORMATION. 

8025 LASER UD FI14753 Rev 10-2015 

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Copyright 2006 Securian Financial Group, Inc. All rights reserved. 

 
 
 
 
 
  
  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Member Name_________________________________ 

(Optional) 

I would like the following Payable-on-Death Beneficiary, who will receive the funds in this account if I die (or, on a joint account, 
when all joint owners die) after all debts owed to the Credit Union are paid: 

POD BENEFICIARY NAME 

ADDRESS 

CITY 

ZIP 

DATE OF BIRTH 

SOCIAL SECURITY NUMBER 

PHONE NUMBER 

RELATIONSHIP TO PRIMARY 

CHOOSE THE PIN NUMBER FOR YOUR DEBIT CARD 

1. Call TELEPIN at 800.224.7670, and enter 50041. (the "client code" for IBMSECU) 
2. Follow the automated instructions to choose your PIN. 
3. Fill in your order# here 
4. Continue to follow automated instructions to choose your PIN. 
� 
� 

(this is not your PIN). 

For an additional Debit Card and PIN for your Joint Owner, please have him/her follow the TELEPIN instructions above, 
and enter the order number here 

(this is not your PIN). 

To use TELEPIN you must be at least 18 years old. Please return within 10 days for processing and qualification. If you need assistance, please call 800.873.5100 ext 4791. We will process 
your request as soon as we receive your application with your unique six-digit "transaction order number" on it. Otherwise, a card cannot be issued. 

OVERDRAFTS 

Your Membership also includes standard Overdraft Protection that automatically transfers funds from your Membership Savings to your Checking, in case there are insufficient funds to pay 
ACH, checks or other items. An Overdraft Transfer Fee may apply, please refer to your current Fee Schedule for details. Please contact the Credit Union if you do not want to take advantage 
of this service, or to set up an alternate overdraft source. 
If you qualify, we may pay ACH, Bill Pay and Check items from your checking account even though it will result in a negative balance. We call this Overdraft Privilege. A Non-Sufficient Funds 
(NSF) or Overdraft Privilege Fee will apply; please refer to your current Fee Schedule for details. We reserve the right to refuse to pay any item. If you have a negative balance, you must 
replenish the funds to a positive balance in accordance with your Membership Disclosure and Overdraft Privilege Agreement. 

Your Membership includes: 

Overdraft Protection that automatically transfers funds from your Membership Savings to your Checking. 

Overdraft Privilege (ODP) to pay your Check, ACH and Bill Pay transactions in case of insufficient funds in your checking account. 

Please check here to also authorize the Credit Union to pay overdrafts for your Debit Card transactions and other items through the ODP program. 

TIN AND BACKUP WITHHOLDING CERTIFICATION Complete the following section: 

Under penalty of perjury, I certify that the number shown on this Application as my Social Security Number or Taxpayer Identification Number is my correct TIN, and that (check applicable 
boxes): 

Primary Member: 

Joint Owner: 

I am not subject to backup withholding due to failure to report interest and dividend income 

I am a U.S. Citizen 

I am subject to backup withholding 

I am a U.S. Citizen 

I am not a U.S. Citizen and agree to complete a W-8 or other applicable form. 

I am not a U.S. Citizen and agree to complete a W-8 or other applicable form. 

_____/______/_____ Date Opened [   ] In Person   [ 

] By Mail  [ 

] Fax  [ 

] SEG 

FOR CREDIT UNION USE ONLY 

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Member Name_________________________________ 

LOAN SERVICES 

STATE NOTICES 

OHIO RESIDENTS ONLY: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain 
separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law. 

WISCONSIN RESIDENTS ONLY: Marital Status: 

Married 

Unmarried 

Legally Separated 

If married:  the name of my spouse is 

Spouse's SSN: 
Notice: No provision of any marital property agreement, unilateral statement under Section 766.59, or court decree under Section 766.70 will adversely affect the rights of the Credit 
Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. 
MARRIED WISCONSIN RESIDENTS APPLYING FOR AN INDIVIDUAL ACCOUNT: By signing here, I state that the credit being applied for, if granted, will be incurred in the interest of 
the marriage or family of the Borrower(s). 

Spouse's Address (if different) 

X 

Please check the box(es) and sign below if you would like to apply for the following loan services. Additional disclosures and important information regarding these loan services are provided 
with this Application.

Yes, I'd like to apply for the Consumer Lending Plan. I would like (check 1 box): 

An Individual Plan for the Primary Member Account Owner listed on page 1. - OR ­
A Joint Plan for the Primary Member Account Owner and the following Joint Account Owner: (name): 

We intend to apply for joint credit. 
FOR CREDIT UNION USE ONLY: 

Verification obtained verbally for each applicant. 

(Member Borrower's initials) 

(Joint Co-Borrower's initials) 

Yes, I'd like to apply for a Credit Card. I would like (check 1 box): 

An Individual Card for the Primary Member Account Owner listed on page 1. - OR ­
A Joint Card for the Primary Member Account Owner and the following Joint Account Owner: (name): 

We intend to apply for joint credit. 
FOR CREDIT UNION USE ONLY: 

Verification obtained verbally for each applicant. 

(Member Borrower's initials) 

(Joint Co-Borrower's initials) 

SEE  IMPORTANT INFORMATION ABOUT CREDIT CARDS 

GROUP CREDIT INSURANCE 

Florida Credit Insurance Acknowledgement Form - Pursuant to Florida Statutes 627.679(1)(c)
By initialing below, (1) I acknowledge that I have the option of assigning any other policy or policies I own or may procure for the purpose of covering this loan and that credit insurance coverage 
need not be purchased from the Credit Union or anyone else in order to obtain the loan. (2) I understand that I must be under a certain age to be eligible for credit insurance and that coverage 
will stop when I reach a certain age, as disclosed in the Application for Group Credit Insurance contained below. (3) I understand that I have 30 days from the date coverage takes effect to 
rescind coverage with a full refund of any premiums that I have paid. 

Applicant Initials	 

Co-applicant Initials 

I would like to apply for the following optional credit insurance on my: 

Consumer Lending Plan 

Credit Card Account 

APPLICATION FOR GROUP CREDIT INSURANCE 
Minnesota Life Insurance Company, 400 Robert Street North, St. Paul, MN 55101-2098 

(Check one or both boxes) 

CREDIT LIFE INSURANCE 
GROUP POLICY NUMBER 
29524-G-500 
MAXIMUM LOAN REPAYMENT PERIOD* 
120 Months 

INSURANCE MAXIMUM 
$50,000 

CREDIT DISABILITY INSURANCE 
GROUP POLICY NUMBER 
29525-G-500 
MAX. AGGREGATE DISABILITY BENEFIT 
$50,000 

MAXIMUM MONTHLY DISABILITY BENEFIT 
$750 
WAITING PERIOD 
30 Days 

MAXIMUM LOAN REPAYMENT PERIOD* 
120 Months 
RETROACTIVE BENEFIT 
Yes 

*NOTE: 

If the maximum loan repayment period is greater than 120 months, loans with repayment periods in excess of 120 months will be insured for full life coverage but only during the first 
120 months. Disability coverage will remain in effect for the entire repayment period of up to 120 months but a maximum of only 60 monthly benefits are payable. 

I (we) are applying for the credit insurance coverage(s) selected below and agree to pay the required premium. I (we) understand that fees may be paid by the insurer in connection with coverage 
to the sponsor of this plan and/or its affiliates or designates. I (we) understand this insurance is voluntary and that I (we) may terminate it at any time. I (we) also agree that: 

1.	  I am eligible for life insurance if I am presently under age 71. In no event is life insurance coverage to remain in force beyond the date you reach age 71.  Please read 

the "When does your insurance terminate?" provision.

2.	  If joint life insurance is selected, we are eligible if the older applicant is presently under age 71. We must be jointly and individually liable under the loan. Co-signers or 
guarantors are not eligible for insurance.  In no event is joint life insurance coverage to remain in force beyond the date the older of the two of you reaches age 71. 
If  insurance  terminates  on  the  older  of  the  two  of  you  due  to  attainment  of  age  71,  insurance  will  continue  on  the  other  debtor  under  single  life  insurance 
coverage. Please read the "When does your insurance terminate?" provision. 

3.	  I am eligible for disability insurance if l am presently under age 71. I also must be presently employed outside the home for wages or profit for 30 hours or more per week and 
have been so employed for 30 days or more before this date. In no event is disability insurance coverage to remain in force beyond the date you reach age 71. 
Please read the "When does your insurance terminate?" provision. 

4. 	 A person signing this application as co-applicant is not eligible for disability insurance. 
The following question must be answered to determine my (our) eligibility for insurance: 

APPLICANT 

CO-APPLICANT 

YES 

NO 

YES 

NO 

During the last two years, have you or your co-applicant been advised of or treated for: cancer, heart attack or coronary artery disease, 
stroke, or cirrhosis; or have you or your co-applicant been diagnosed for Acquired Immune Deficiency Syndrome (AIDS)? 

My (our) answer to the above question is true to the best of my (our) knowledge and belief. If either my co-applicant or I answer "Yes" to this question, we understand that we are not eligible 
for insurance and will not be insured. 
The effective date of my (our) insurance will be the date of this application, the date the eligible loan is disbursed, or the date the note evidencing the loan is signed, whichever date is later. 
Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading 
information is guilty of a felony of the third degree. 

COVERAGE REQUESTED (*MONTHLY PREMIUM PER $1,000.00 OF OUTSTANDING LOAN BALANCE.) 

Yes 

No 

Single Life

$0.62* 

Yes 

No 

Joint Life 

$1.05* 

Yes 

No  Credit Disability 

$1.82* 

APPLICANT'S SIGNATURE 

X 
99-60027.9 Rev. 4-2003 
8025 LASER UD FI14753 Rev 10-2015	 

DATE 

CO-APPLICANT'S SIGNATURE (Joint Life Only) 

DATE 

X 

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Copyright 2006 Securian Financial Group, Inc. All rights reserved. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
Member Name_________________________________ 

AGREEMENT TO TERMS - CONSUMER LENDING PLAN 

If your Consumer Lending Plan loan application is approved, by signing below, you agree to the following terms: 

"You", "Your" and "Borrower", means any person who executes the Plan by signing the Agreement to Terms, or any person who endorses a proceeds check or otherwise accepts, 

accesses, or uses Plan funds. "We", "us", "our" or "Credit Union" means IBM Southeast Employees' Credit Union (IBMSECU) 

How the Plan Works. This Consumer Lending Plan has a variety of subaccounts under which you may take various types of loans (called "advances"). Some 
subaccounts may be revolving (e.g., Personal Line of Credit). The credit available under these subaccounts will replenish as you pay down the balances. Other 
subaccounts are single-advance subaccounts such as New Auto. These subaccounts will not replenish and will have a set term. 

Binding  Contract.  This  Consumer  Lending  Plan,  which  includes  the  Credit  Agreement,  Security  Agreement,  Truth-in-Lending  Statement,  and  all  Advance 
Receipts ("Plan"), becomes a binding legal contract with regard to each advance as soon as you take an advance, and will govern the terms of all loans that 
you  obtain  under  the  Plan.  You only  sign  once  to  open  the  Plan;  thereafter,  you  may  request  additional  advances  without  signing  any  paperwork  unless 
requested by us. You become obligated on a particular advance when you receive the advance proceeds or the benefits thereof. 

By signing below, you are: 

1.	  Agreeing to repay all loans you take. All loans you take under the Plan must be paid back, even if you don't sign any paperwork at the time of the loan. 
You promise to pay all future and present fees, charges, costs and expenses incurred in collecting a debt from you, including reasonable attorney fees. 
2.	  Pledging your shares and deposits in the Credit Union. If  you default, we may apply the shares and deposits in your accounts to the amount you 
owe us. We may also prevent you from withdrawing shares or deposits if you are in default, or, in the case of a share-secured or deposit-secured loan, if 
such withdrawal would cause your balance to fall below what you owe. All debts are immediately due and payable upon death, superseding the rights of 
any joint owners or beneficiaries. Lien rights obtained prior to death on loans and credit cards will continue to encumber your shares and deposits after 
death. Your pledge and our lien rights do not include any IRA, Keogh or other account which would lose special tax treatment if pledged. Please see the 

3.	  Security Agreement for complete details. 

Granting a security interest in all property you purchase or otherwise pledge. If you default on any subaccount under the Plan, we may seize and 

4.	  sell any property you have purchased or pledged under that subaccount or any other subaccount. 

Cross-Collateralization: All other collateral you have pledged for any other loan with us (except your home and household goods) will also secure this 

5.	  Plan. 

Release of Lien: We will not release a lien on any of the collateral you have pledged if you are delinquent or in default on any of your subaccounts. For 
example: if you are in default of your signature loan subaccount, we will not release our lien on your vehicle loan, even if the vehicle loan is paid in full. 
Please see the Security Agreement for complete details. 

Interest  Rates  and  Fees.  The  rates  and  fees  that  apply  to  your  subaccounts  are  disclosed  on  the  separate  Truth-in-Lending  Statement  and/or  Advance 
Receipt. 

Notice  to  Applicants  residing  in  Community  Property  States:  When  applying  for  secured  or  unsecured  credit  where  both  parties'  incomes  are  being 
considered  as  a  basis  for  repayment  for  loan  approval,  the  Credit  Union  requires  a  joint  application  signed  by  both  parties,  with  the  debt  of  both  parties 
disclosed. A current  credit  report  will  be  obtained  on  both  parties  to  verify  debt,  and  verification  of  income  is  required.  Information  about  the  party  making 
payments is also required if you are relying on alimony and/or child support as a basis for repayment on an individual application. A current credit report and 
verification of income is required. 

Acknowledgement: You acknowledge that you have read, understand and accept the terms and conditions of the Consumer Lending Plan, Credit Agreement 
and Security Agreement, and have received copies of these documents. You also understand that you will receive a Truth-in-Lending Statement at the time of a 
single-disbursement advance, and at the time that you open a revolving subaccount. You agree to be bound by all Advance Receipts or similar documents and 
the Truth-in-Lending Statements, and understand that by endorsing any advance proceeds check, or by otherwise accepting, using or accessing your advance 
proceeds, you are bound to the aforementioned documents. 

Governing Law: You understand and agree that this agreement, and all subsequent amendments and addendums, will be governed by applicable Federal law 
and the laws of the State of Florida. 

SECURITY INTEREST: You understand and agree that, in exchange for all loans you may receive under this Plan, that you grant a security interest 
in any and all property that you purchase or otherwise pledge for those loans. This means we will have a lien on that property and may seize and 
sell the property if you are in default on any loan under this Plan. You understand and agree that the property will be described on the Advance 
Receipt  that  you  receive  at  the  time  of  the  advance,  and  that  this  collateral  description  is  incorporated  as  a  valid  part  of  granting  this  security 
interest. You understand and agree to the security interest even though the property will be described at a later date and even though you do not 
sign the Advance Receipt. 

NOTICE TO CONSUMER: THIS IS A CONSUMER CREDIT TRANSACTION. (A) DO NOT SIGN ANYTHING BEFORE YOU READ IT OR IF IT CONTAINS
 
ANY BLANK SPACES. (B) YOU ARE ENTITLED TO AN EXACT COPY OF ANY AGREEMENT YOU SIGN. (C) YOU HAVE THE RIGHT AT ANY TIME TO
 
PAY IN ADVANCE THE UNPAID BALANCE DUE UNDER THIS AGREEMENT. 

SIGNATURE OF MEMBER APPLICANT 
X 

DATE 

SIGNATURE OF JOINT CO-APPLICANT 
X 

DATE 

HAVE YOU OMITTED ANYTHING? REMEMBER: INCOMPLETE APPLICATIONS CANNOT BE PROCESSED. 

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