We just need a little information about you.
Please provide any joint member information for the new account, or just click next to skip this section.
Account Type of Interest (Select all that apply)
Ownership of Account (Select one)
Signature and Certification
MEMBER’S BACKUP WITHHOLDING CERTIFICATION – Select A or B below only if true.
By signing below, you certify under penalty of perjury that: 1. The taxpayer identification number (TIN) show for me above is my correct taxpayer identification number, and, 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 interests 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). *Notify us in the NOTES section if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.
A separate form W-9 has been completed (or W-8 in the case of a non-resident alien).
Signatures of Member and Joint Account Holder(s)
Thank you for your member application!
An LLCU representative will reach out to you during our normal business hours of M-F 8:30a-5p.
Here is what you shared with us:
|Your Date of Birth|
|Your Mother's Maiden Name|
|Your Drivers License|
|Your Phone Number|
|Your Employer||Joint name|
|Joint Date of Birth|
|Joint Drivers License|
|Joint Phone Number|
|You are request a new account with the following types:|
|The ownership type of the account requested is:|
|The backup withholding type of the account requested is:|
|Best time to contact you|
One of our Membership
experts will be calling you
We’ll ask you to complete an application for Membership
You’re account will be opened!