Taupa Lithuanian FCU

Eligibility

What account would you like to open?

Savings Certificate Checking

Account type

Individual Joint

Applicant's name (First, M, Last) *

Birthday*

Mother's Maiden Name*

Social Security Number*

Place of Birth*

Driver's License Number

Driver's License State

Present Address*

Home Phone*

Business Phone

Email Address*

Employed by*

Start Date*

Income*

By completing and submitting this document, I certify, under penalties of perjury

that the Social Security Number (SSN)/Taxpayer Identification Number (TIN) shown is my/the correct number

that I am NOT, unless designated below, 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 dividends or interest, or because the IRS has notified me that I am no longer subject to backup withholding