CLUB ACCOUNTS VACATION {J Transfer to Shares HOLIDAY x] Transfer to Shares Account No || J Single Account Transfer to Checking Transfer to Checking Joint Aci Stay in Stay in Member Name Social Security Numb ome r City State je Pp Date of Birth Place of Birth Home Phone 2 NYSDL 11/0 ID Type ID Number ID Description ID Ex INFORMATION ON JOINT MEMBER Name Social Security Numb Home Address City State Work Phone Number Home Phone Employer Name ID Type ID Number ID Description ID Ex The undersigned acknowledges receipt of a copy, and agrees to be governed by the rules and regulations of the Municipal Credit Union applicable to Vac: Club Accounts as now in effect and as amended from time to time. Under penalties of perjury, I certify (1) that the number shown on this form is my correct taxpayer identification number; and (2) that I am not s withholding either because I have not been notified that I am subject to backup withholding as a result of failure to report all interest or dividenc Revenue Service has notified me that I am no longer subject to backup withholding. SIGNATURE OF PRIMARY MEMBER SIGNATURE OF JOINT MEMBER 01/21/09 DATE 01/21/09 DATE EFTA00124680