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* Use a dark background

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Recommendation for best recognition:

* Use a dark background

* Make sure all four corners are visible

* Avoid glare

* Make sure image is in focus

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Personal Information

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First Name

Middle Name

Last Name

Suffix (Jr., Sr., etc.)

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Mother's Maiden Name

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Address

Zip

City

State

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Mailing Address

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Address

Zip

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State

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About Your Employment

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In some cases, 100 cannot be divided evenly by the number of beneficiaries When this occurs, the amount of the first beneficiary will be increased to make the total equal 100%.

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Consumer Accounts
By Clicking “I Agree” below, I accept and agree to the terms and conditions established by the Board of Directors for the designated account(s) requested on this application and as stated in the Truth-in-Savings Disclosure titled “Important Account Information for our Members” and/or any other pertinent disclosure(s), a copy of which has been given to me, or will be mailed to me upon opening this account(s). I authorize the Credit Union to investigate my credit report prior to issuance of the MasterCard Debit Card. If I request but am not approved for a MasterCard Debit Card, you may send me an ATM card. I agree to be liable for all fees and charges charged to my Sharedraft account including the applicable annual or monthly membership fee(s) listed in the fee schedule you gave with the Consumer ATM/Debit Card Agreement (the “Agreement”). I will read the agreement. And, by using the Card(s), I will be agreeing to the terms of the Agreement.

I recognize that as a member of HawaiiUSA Federal Credit Union (“HawaiiUSA FCU”), from time to time I may be offered or may request that certain loan or other credit facilities be made available to me in conjunction with my membership. In order to assist HawaiiUSA FCU in determining qualification for any such loan or credit facility, I hereby authorize HawaiiUSA FCU to obtain a consumer report from any consumer-reporting agency as HawaiiUSA FCU may request. This authorization shall be effective from the date of execution until I give written notice to HawaiiUSA FCU that I have revoked such authorization. Such written notification is to be mailed by certified mail, return receipt requested, to: HawaiiUSA FCU, Attn: Loan Manager, 1226 College Walk, Honolulu, Hawaii 96817.

I certify that the information provided in this application is true and correct.

Account holder certifies under penalty of perjury, that (1) the Social Security Number shown is his/her correct taxpayer identification number and (2) he/she is not subject to backup withholding because (a) he/she is exempt from backup withholding or (b) he/she has not been notified by the IRS that he/she is subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified him/her that he/she is no longer subject to backup withholding and (3) I am a U.S. person (including a U.S. resident alien). The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

Business Accounts
By Clicking “I Agree” below, I accept and agree to the terms and conditions established by the Board of Directors for the designated account(s) requested on this application and certify that the information provided in this application is true and correct.

I agree and consent to the terms in HawaiiUSA FCU's E-Sign Consent and Disclosure

I acknowledge receipt of the Important Account Information For Our Members

I acknowledge receipt of the Schedule of Fees

Standard text message rates may apply.

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Product Type	Maximum Deposit	Your Requested Deposit
Checking
Savings
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