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BUCKEYE STATE CREDIT UNION
INTERNET MEMBERSHIP APPLICATION


If you choose not to submit this form via the internet, you can fill it out and print it and then mail or fax it to Buckeye State Credit Union.
 
Submitted online applications are securely transmitted. Once the branch reviews the information, they will contact you. You will be asked to visit your local branch to sign the final paperwork to become a member.
 
MEMBERSHIP REQUIREMENTS
In order to be a member of Buckeye State Credit Union, you must fit one of the criteria below.
  1. Be a relative of someone who is currently a member of Buckeye State Credit Union.
  2. Live, work, worship, or attend school in the City of Shaker Heights, Lake County, Summit County, or Stark County, Ohio.
  3. Employed by one of the companies that are part of the Buckeye State Credit Union's Select Employer Groups. If you are not sure your employer is part of the Select Employer Group, you can find out by clicking on the "List of eligible employers" drop down menu shown below and viewing all the current eligible employers.
  4. Deposit $5.00 to open account. That $5.00 has to remain on deposit as long as you have an account.
  5. Two forms of valid I. D., for a list of valid I. D., click here
  6. Requirements for checking accounts: We screen though CHEXSYSTEMS and a $25.00 deposit is required to open a checking account.

Your location:
 
 


I am eligible for membership through 

Enter the name of the Employer or Family member or Lake, Stark, Summit Counties Community Charter

If a Family Member, Enter their BSCU Account Number


Please provide the following contact information:
First Name
Last Name
Middle Initial
Title
Home Street Address
Address 2
City
State/Province
Zip/Postal Code
County
Eligible to join thru
Work Phone
Home Phone
FAX
E-mail
Social Security or TIN #
* Driver License #
Issuing State
Date of Birth
Mother's Maiden Name
* If you do not have a Driver License enter N/A

Under penalties of perjury, I certify that:
  1. The number shown of this form is my correct Social Security or Taxpayer identification number,
  2. 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
  3. I am a U.S. person (including a U.S. resident alien).

Is there a second person to be added to this Primary Account?  YES     NO


Joint Owner #2 Information:
Please provide the following contact information:
First Name
Last Name
Middle Initial
Title
Home Street Address
Address 2
City
State/Province
Zip/Postal Code
County
Eligible to join thru
Work Phone
Home Phone
FAX
E-mail
Social Security or TIN #
* Driver License #
Issuing State
Date of Birth
Mother's Maiden Name
* If you do not have a Driver License enter N/A

Under penalties of perjury, I certify that:
  1. The number shown of this form is my correct Social Security or Taxpayer identification number,
  2. 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
  3. I am a U.S. person (including a U.S. resident alien).


I hereby make application for membership in and agree to conform to the Bylaws, as amended, of Buckeye State Credit Union (the "Credit Union"). I certify that I am within the field of membership of this Credit Union; the information provided on this application is true and correct. I also agree to be bound to the terms and conditions of any account I have in the Credit Union now or in the future.