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Lorain County Elyria Ohio 44035 340 Griswold Road, Credit Union, Inc.

340440.324.3400 or Elyria Ohio 44035 Griswold Road, 800.451.6315 440.324.3400 or 800.451.6315 www.selccu.org www.selccu.org

SCHOOL EMPLOYEES SCHOOL EMPLOYEES Lorain County Credit Union, Inc.

ApplicationAccountProducts and for Number ____________

Information Account Number ____________

Office Use Only

440.324.3400 or 800.451.6315 www.selccu.org

Checks ____________________________ Applicant Name ____________________________________________________SSN _______________________ Birthdate ____________ Mother's Maiden Name _____________________ www.selccu.org Lorain County Credit Union, Inc. Address_____________________________________________________________ City___________ VISA® _____________________________________________ Address_____________________________________________________________ City_____________________________________________State_______ZIP_______________________ Office Use Only 340 Griswold Road, Elyria Ohio 44035 ChexSystems________________________ Address_____________________________________________________________ City_____________________________________________State_______ZIP_______________________ Operations _________________________ 440.324.3400 or 800.451.6315 Home Phone _________________________________Work Phone_____________________________ Applicant Name__________________________________ SSN____________Birthdate_________Mother's____________________________ Maiden Name______________ Checks Home Phone _________________________________Work Phone_______________________________________Cell Phone ____________________________________ www.selccu.org VISA® _____________________________________________ Home Phone _________________________________Work Phone_______________________________________Cell Phone ____________________________________ Address________________________________________ City______________________________State___________Zip______________ Co-Applicant Name__________________________________________________SSN ____________ ChexSystems________________________ Information Co-Applicant Name_________________________________________________SSN _______________________ Birthdate ____________ Mother's Maiden Name _____________________ Applicant Name ____________________________________________________SSN _______________________ Birthdate ____________ Mother's Maiden Name _____________________ Co-Applicant Name_________________________________________________SSN _______________________ Birthdate ____________ Mother's Maiden Name _____________________ Address_____________________________________________________________ City___________ Home Phone____________________________Work Phone____________________________Cell Phone___________________________ Address_____________________________________________________________ City_____________________________________________State_______ZIP_______________________ Information Address_____________________________________________________________ City_____________________________________________State_______ZIP_______________________ Address_____________________________________________________________ City_____________________________________________State_______ZIP_______________________ Home Phone _________________________________Work Phone_____________________________ Applicant Name ____________________________________________________SSN _______________________ BirthdatePhone ____________________________________ Home Phone _________________________________Work Phone_______________________________________Cell ____________ Mother's Maiden NameName______________ Co-Applicant Name_________________________________ SSN____________Birthdate_________Mother's Maiden _____________________ Home Phone _________________________________Work Phone_______________________________________Cell Phone ____________________________________ Home Phone _________________________________Work Phone_______________________________________Cell Phone ____________________________________ Address_____________________________________________________________ City_____________________________________________State_______ZIP_______________________ Co-Applicant Name__________________________________________________SSN _______________________ Birthdate ____________ Mother's Maiden Name_____________________ Address________________________________________ City______________________________State___________Zip______________ Services Requested Co-Applicant Name_________________________________________________SSN Co-Applicant Name__________________________________________________SSN _______________________ Birthdate ____________ Mother's Maiden Name _____________________ Name_____________________ Home Phone _________________________________Work Phone_______________________________________Cell Phone ____________________________________ Direct Deposit/Payroll Deduction (Separate form required.) Address_____________________________________________________________ City_____________________________________________State_______ZIP_______________________ Home Phone____________________________Work Phone____________________________Cell Phone___________________________ Address_____________________________________________________________ City_____________________________________________State_______ZIP_______________________ Address_____________________________________________________________ City_____________________________________________State_______ZIP_______________________ Overdraft Protection Co-Applicant Name_________________________________________________SSN _______________________ Birthdate Phone ____________________________________ Home Phone _________________________________Work Phone_______________________________________Cell ____________ Mother's Maiden Name _____________________ Account # _________________________ Home Phone _________________________________Work Phone_______________________________________Cell Phone ____________________________________ Home Phone _________________________________Work Phone_______________________________________Cell Phone ____________________________________ Co-Applicant Name_________________________________ SSN____________Birthdate_________Mother's Maiden Name______________ VISA® Check Card (Subject to qualification.) Address_____________________________________________________________ City_____________________________________________State_______ZIP_______________________

Information Office Use Only 340 Griswold Co-Applicant Name_________________________________________________SSN _____________ Information____________________________________________________SSN _______________________ Birthdate ____________ Mother's Maiden_________________________ SCHOOL Road, Elyria Ohio 44035 Account Number ____________ Operations Name _____________________ Applicant Name 440.324.3400 or 800.451.6315 Information EMPLOYEES

Application for Products and Services SCHOOL EMPLOYEES Application Union, Inc. for Products and Services Lorain County Credit

OperationsOffice Use Only _________________________ Applicant Name ____________________________________________________SSN _____________ Operations _________________________ Checks ____________________________ Checks ____________________________ VISA® _____________________________________________ Address_____________________________________________________________ City___________ ChexSystems________________________ VISA® _____________________________________________ ChexSystems________________________ Account Number ____________ Home Phone _________________________________Work Phone_____________________________

Application for Products and Services Application for Products and Services

Co-applicant VISA® Check Card Address________________________________________ City______________________________State___________Zip______________ Co-Applicant Name__________________________________________________SSN _______________________ Birthdate ____________ Mother's Maiden Name_____________________ Services Requested Home Phone _________________________________Work Phone_______________________________________Cell Phone ____________________________________ Overdraft Protection Co-Applicant Name__________________________________________________SSN _______________________ Birthdate ____________ Mother's Maiden Name_____________________ Overdraft Protection Home Phone _________________________________Work Phone_______________________________________Cell Phone ____________________________________ Co-applicant ATM Card Account # _________________________ Address_____________________________________________________________ City_____________________________________________State_______ZIP_______________________ Account # _________________________ Touch-Tone Teller ® Direct Deposit/Payroll Deduction (Separate form required.) Checking Access Share Savings Access Both

Services Requested Deduction (Separate form required.) ATM Card Direct Deposit/Payroll Address_____________________________________________________________ City_____________________________________________State_______ZIP_______________________ Home Phone____________________________Work Phone____________________________Cell Phone___________________________

VISA Check Card (Subject to qualification.) VISA® Check Card (Subject to qualification.) Home Phone _________________________________Work Phone_______________________________________Cell Phone ____________________________________ www.selccu.org.) Co-applicant VISA Please see reverse Free Online Services (Available through our Web site side for Services Requested® Check Card Co-applicant VISA® Check Card reverse side ATM Card · SELCCU Online Please see Application. for Direct Deposit/Payroll Deduction (Separate form required.) Loans ATM Card Loans Application. · Bill Pay Checking Access Share Savings Access Both Requested ServicesOverdraft Protection Share Savings Access Both Checking Access · e-Statements Co-applicant ATM Card Account # _________________________ Direct Deposit/Payroll Deduction (Separate form required.) · e-News E-mail Address (required) ___________________________ Co-applicant ATM Card Touch-Tone Teller (Subject to qualification.) ® VISAProtection All members with e-mail addresses will receive information on special Overdraft Check Card Touch-Tone Teller Co-applicant VISA(Available through Free Online_________________________ our Web site www.selccu.org.) events and promotions.Please see reverse side for Services ® Check Card Account # Free Online Services (Available through our Web site www.selccu.org.) Check Card (Subject to qualification.) · ®SELCCU VISAATM Card Online Loans Application. · SELCCU Online · Checking Access Bill Pay Co-applicant VISA® Check Share Savings Access Both Card Pleasedeposit to reverse side for days to receive yo see open is $25. Allow 7-10 business Checking Accounts Minimum · Bill Pay · e-Statements ATM Co-applicant ATM Card (required) ___________________________ · Card e-Statements Address Loans Application. · e-News E-mail Teller M3 Checking (ages 13-17) ......................................... Check Style Cod · Checking Access Address (required) Access information on special Touch-Tonewith e-mailShare Savings ___________________________ Alle-News E-mail addresses will receive Both members Young Adult Checking (ages 18-25) .......................... Check Style Cod Co-applicantpromotions. addresses will receive information on special events and with e-mail FreeAll membersATM Card (Available through our Web site www.selccu.org.) Online Services events and promotions. A+ Checking* ............................................................... Check Style Cod Touch-Tone Teller · SELCCU Online *Requires minimum balance/deposit to avoid monthly fee. · Bill Pay Checking Accounts Minimum deposit our Web site www.selccu.org.) mail. See rate schedule for fees. Free Online Services (Available throughto open is $25. Allow 7-10 business days to receive your checks byAdvantage Checking (age 55 and older) .......... FREE Prime Adv · e-Statements Prime Checking Accounts Minimum deposit to open is $25. Allow 7-10 business days to receive your checks by mail. See rate schedule for fees. · SELCCU Online · e-News E-mail Address (required) ___________________________ M3 Checking (ages · BillAll members with e-mail 13-17) ......................................... Check Style Code: 1. Name(s) on your checks Applicant only Applicant and Co-A Pay addresses will receive information on special M3 Checking (ages 13-17) ......................................... Check Style Code: 2. If you wish to have your new checks sent to another address, please · e-Statements Adult Checking (ages 18-25) .......................... Check Style Code: Young promotions. events and Adult Checking (ages 18-25) .......................... Check Style Code: Young Address (required) ___________________________ _______________________________________________________ · e-News Checking* ............................................................... Check Style Code: A+ E-mail A+ with e-mail addresses will receive information on special All membersChecking* ............................................................... Check Style Code: 3. Would you like to have your phone number on your checks? *Requires minimum balance/deposit to avoid monthly fee. events and Accounts balance/deposit to avoid monthly fee. *Requires minimum Checkingpromotions. Minimum deposit to openand older) .......... FREE Prime Advantage checks or Check Style fees. is $25. Allow 7-10 business days to receive your checksBeginning Check Number____________________ by mail. See rate schedule for 4. Prime Advantage Checking (age 55 Code: Prime Advantage Checking (age 55 and older) .......... FREE Prime Advantage checks or Check Style Code: Applicant only Applicant Style Code: 1. Checking on your checks ......................................... Check and Co-Applicant M3 Name(s) (ages 13-17) 1. on your checks Applicant Co-Applicant Checking 2. Name(s) Checkingyouropen ischecks sent only Applicant andyour checks Requires parental acknowledgement form and successful completion of C Accounts wish to have (ages 18-25) ..........................address,Style Code: by mail. See rate schedule for fees. Minimum deposit to new $25. Allow 7-10 business days to receive If you to another Check please indicate here: Young Adult Available 2. If you wish to have your new checks sent to another address, please indicate here: to Prime Advantage Club members at a discounted price. ___________________________________________________________________________________________________________ A+ Checking* ............................................................... Check Style Code: M3 Checking (ages 13-17) ......................................... Check Style Code: ___________________________________________________________________________________________________________ 3. Would you like to have your phone number on your *RequiresChecking balance/deposit to avoid monthly fee.checks? Code: Yes No Young Adult minimum (ages 18-25) phone number on your checks? 3. Would you like to have your .......................... Check Style Yes No 4. Beginning Check Number____________________ FREE Code: Prime Advantage Checking (age 55 and older) .......... A+ Checking* ............................................................... Check StylePrime Advantage checks or Check Style Code: 4. Beginning Check Number____________________ Signatures 1. Name(s) on your checks Applicant only Applicant and *Requires minimum balance/deposit to avoid monthlysuccessful completion Co-ApplicantQuiz. undersigned has applied for membership with SELCCU; Rev 10/11its by-laws an fee. Requires parental acknowledgement form and of Checking the By signing below, agrees to 2. If you wish to have your here: authorizes SELCCU verify credit and history by including Requires to Checking (age new checks sent to discounted price.please indicate Quiz. Check StyleisCode: Rev 10/11 Prime AdvantagePrime acknowledgement older)andat aanother address,Advantage checks ortoon the application employmentcorrect, andany necessary means,applicationprepa Available parental Advantage55 and form .......... FREE Prime Club members successful completion of Checking information provided true and that the terms on the apply ___________________________________________________________________________________________________________ Availableon your checks Applicant onlyat discounted price. edges receipt of the named disclosures and the terms that apply to the above referenced accounts. to Prime Advantage Club members a Applicant and Co-Applicant 1. Name(s) 3. Would you like to have checks sent to another address, please Yes 2. If you wish to have your newyour phone number on your checks? indicate here: No 4. Beginning Check Number____________________ ___________________________________________________________________________________________________________ X Signatures 3. Would like to have on Yes No Signatures youundersigned hasyour phone number withyour checks? to its by-laws and the terms and conditions of any approved account, as amended from time to time; and Applicant Signature By signing below, the parental acknowledgement form and SELCCU; agrees applied for membership Requires successful completion of Checking Quiz. Rev 10/11 4. Beginning Check Number____________________ agrees including preparation of a credit report by a credit reporting account, as undersigned certifies time; and authorizes SELCCU toundersigned and applied for membershipany necessary means, to its by-laws and the terms and conditions of any approved agency. The amended from time to that the verify credit has employment history by with SELCCU; By signing below, the Available to Prime Advantage Club members at a discounted price. apply to all accounts report the credit reporting agency. The undersigned certifies that the information provided on the application employment historyandany necessary means,applicationpreparation of a credit held byby a undersigned at this credit union. The undersigned acknowlis true and correct, by that the terms on the including authorizes SELCCU to verify credit and X X edges receipt of the named application is true and correct, and to the terms on the application apply to all accounts held by the undersigned at this credit union. The undersigned acknowlinformation provided on thedisclosures and the terms that applythatthe above referenced accounts. edges receipt of the named disclosures and the terms that apply to the above referenced accounts. Co-Applicant Signature Date10/11 C Requires parental acknowledgement form and successful completion of Checking Quiz. Rev Available to Prime Advantage Club members at a discounted price. X Signatures X Applicant Signature Date By signing below, has with SELCCU; agrees account, as Applicant Signature the undersigned and applied for membershipany necessary means, to its by-laws and the terms and conditionsaof any approved agency. The amended from time to that the Datetime; and authorizes SELCCU to verify credit employment history by including preparation of a credit report by credit reporting undersigned certifies information provided on the application is true and correct, and that the terms on the application apply to all accounts held by the undersigned at this credit union. The undersigned acknowlSignatures receipt of the named disclosures and the terms that apply to the above referenced accounts. X X edges X X Co-Applicant Signature Date Co-Applicant Signature Date By signing below, the undersigned has applied for membership with SELCCU; agrees to its by-laws and the terms and conditions of any approved account, as amended from time to time; and Co-Applicant Signaturecredit and employment history by any necessaryDate including preparation of a credit report by a credit reporting agency. The undersigned certifies that the Co-Applicant Signature Date authorizes SELCCU to verify means,

information provided on the application is true and correct, and that the terms on the application apply to all accounts held by the undersigned at this credit union. The undersigned acknowledges receipt of the named disclosures and the terms that apply to the above referenced accounts.

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