_________________________________________________ V. SIGNATURES _________________________________________________

By signing below, the undersigned agree to the Credit Union by-laws and the terms and conditions of any approved account, as amended from time to time, and authorize the Credit Union to verify credit and employment history by any necessary means, including preparation of a credit report by a credit reporting agency on the undersigned, as individuals. The undersigned certify that information provided on this Application is true and correct and that the terms on the Application apply to all accounts held by the undersigned at this Credit Union. By checking the boxes below, the undersigned acknowledge receipt of the named disclosures and the terms and conditions that apply to any approved account.

[  ] Truth in Savings     [  ] Electronic Fund Transfers    [  ] Funds Availability   [  ] Privacy   [  ] _________________________________________

1. Member's Signature X ___________________________________________________________ Date ________________________________

2. Signature X ___________________________________________________________________ Date ________________________________

3. Signature X ___________________________________________________________________ Date ________________________________
  

The individual signing on line _________ is signing as:
[  ] Convenience Account Agent

[  ] A Successor Custodian of a TUTMA Account
[  ] ______________________________________________________


_______________________________________
VI. ADDITIONAL SERVICES REQUESTED _______________________________________
  

Please select the type of additional services you are interested in by checking items below.
  

[  ] ATM/CueCard (Debit Card)
[  ] HomeBranching (On-Line Banking)
[  ] MARS (Audio Response)

[  ] WriteLine (LOC) Loan (Overdraft Protection)
[  ] Mastercard
[  ] Consumer Loan

[  ] Real Estate Loan
[  ] Bill Pay
[  ] Member Financial Services

  

  

  

  

  

  

  

 

 

  

  

  

  

  

  

  

  © 1993 Bankers Systems, Inc., St. Cloud, MN  Form  MAP-LAZ-TX 1/21/2001    Customized                                               (page 2 of 4)