Share Certificate Details

• Certificate Amount
  OK Certificate Amount is required
• Certificate Term ($500 minimum) 3 month6 month12 month18 month24 month30 month36 month48 month60 month
  Optional OK Certificate Term ($500 minimum) is required
• Step-Up Certificate Term ($2,500 minimum) 24 month30 month36 month48 month60 month
  Optional OK Step-Up Certificate Term ($2,500 minimum) is required

Member Information

• Member Name
  OK Member Name is required
• Social Security Number
  OK Social Security Number is required
• Primary Phone
  OK Primary Phone is required
• Email Address
  OK Email Address is required
• Street Address
  OK Street Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required
• Date of Birth
  OK Date of Birth is required

Disclosure

I present this request and certify that all statements are true and complete to the best of my knowledge and for the purpose of opening a Share Certificate with the Credit Union and that no unfavorable information known to me or called for herein has been omitted. I authorize the Credit Union to obtain such information as you may require concerning this share request. I agree that this request remain the property of the Credit Union.

• OK is required