Heritage Hub FCU — Membership Intake

Welcome. Complete the sections below to apply for membership. Fields marked * are required. You can upload supporting documents from your phone, camera, or computer — any file type is accepted (PDF, HEIC, JPG, Word, etc.). Your information is confidential.

Application type:

Simple: quick single-owner membership. Switch to Full for multi-owner entities requiring beneficial-ownership & BSA details.

1Business Information *

Legal Business Name *Required

DBA / Trade Name (if any)

Federal Tax ID (EIN) *Required

Date Established (MM/YYYY) *Required

State of Formation

Entity Type *

Business Address

Physical Address (no P.O. Box) *Required

City *Required

State *Required

ZIP *Required

Mailing Address (if different)

City

State

ZIP

Business Phone *Required

Business Email *Valid email required

Website (if any)

NAICS Code (if known)

Primary Business Purpose / Nature of Business *Required

3Owner Information *

Federal regulation (31 CFR § 1010.230) requires identifying every individual owning 25%+ of the entity, plus one individual with significant managerial control. List all qualifying owners (up to four).

4Control Person *

The individual with significant responsibility to manage or direct the entity (e.g., CEO, Managing Member, Treasurer).

Same as Beneficial Owner

Full Legal Name

Title / Position

Date of Birth (MM/DD/YYYY)

SSN / ITIN

Residential Address

City

State

ZIP

Phone

ID Type

ID Number

Issuing State / Country

Expiration Date

5Authorized Signers

Individuals authorized to transact on the account. Each signer must be a member or eligible to become one. Attach an authorizing resolution if signers aren't in the formation documents.

6Membership Eligibility *

How does the applicant qualify for membership in Heritage Hub FCU? (Check all that apply.)

Select Employer Group (SEG), if any

Immediate family/household member of existing member (name)

Other (explain)

7Account Selection *

Share Savings — required to establish membership ($5 minimum par value) Share Draft (Checking) Money Market Certificate of Deposit (CD)

CD Term (months)

CD Amount ($)

Other account

Initial Deposits

Membership Fee (Par)

Initial Savings ($)

Initial Checking ($)

Initial CD / MM ($)

8Beneficiary Designation (Payable on Death) — optional

Optional. Applies to accounts permitting POD designation. Total share percentages must equal 100%.

9Document Upload *

Upload from your phone, camera, or computer. Any file type is accepted (PDF, HEIC, JPG, PNG, Word, etc.). You can add multiple files per box. Max 25 MB per file.

10Disclosures, Consents & Signature *

USA PATRIOT Act Notice

To help the government fight the funding of terrorism and money laundering, federal law requires all financial institutions to obtain, verify, and record information identifying each person and entity that opens an account. We may ask to see identifying documents.

Certification of Beneficial Ownership

I certify that the information provided in the Owners and Control Person sections is complete and correct, and I will notify Heritage Hub FCU of any change in beneficial ownership or control within 30 days.

Consent to Verify Information

I authorize Heritage Hub FCU to verify the information in this application, including obtaining consumer and business credit reports on the entity, owners, control person, and authorized signers, and to share information with affiliates and service providers as permitted by law (15 U.S.C. § 1681).

Electronic Communications Consent (E-SIGN) * — I consent to receive disclosures, statements, and notices electronically per the federal E-SIGN Act. I may withdraw consent at any time by contacting the Credit Union.

Agreement

I hereby apply for membership in Heritage Hub Federal Credit Union and agree to be bound by its bylaws, Membership and Account Agreement, Truth-in-Savings disclosures, Funds Availability Policy, Privacy Notice, and Fee Schedule, as amended. I certify that all information provided is true, complete, and correct, and that I am duly authorized to bind the business.

I have read and agree to the statements above. *

Authorized Signer Name (printed) *Required

Title *Required

Date *Required

Electronic Signature *

By checking this box and signing below, I adopt the signature as my electronic signature and agree it is the legal equivalent of my handwritten signature under the federal E-SIGN Act and UETA. *

Not signed yet