Checking Account

Welcome! Please fill out this form if you are an existing member and would like to add a checking account.

You can choose to receive a free debit card and/or box of checks!

Refer a friend to open an active checking account and you both will receive $100!

Are you filling this form out in our lobby? *

Member Service Rep Identification Code: *

Full Name *

First Name Last Name

Best Contact Phone Number *

Your Illinois State Credit Union Account Number: *

Is all your contact information the same? (Address, E-mail, Phone, Etc.) *

Yes No

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail

Is there a joint owner on your account? *

Yes No

Full Name *

First Name Last Name

Is joint's address same as the primary account owners?

Yes No

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail

Phone Number *

Would you like a box of checks? *

Yes No

What type of checks would you like? *

Duplicates (with carbon copy of the check) Singles (NO carbon copy)

Where would you like your checks delivered? *

Home Address My Credit Union

Would you like a free debit card? *

Yes No

We will not order the debit card until the account is funded.

Where would you like your debit card delivered? *

Home Address My Credit Union

Would you like to set up overdraft protection? *

Yes No (your overdraft checks and electronic transfers (ACH) will be returned if you choose this option.)

Would you like us to fund your new checking account by making a transfer from your Illinois State Credit Union savings account? *

Yes No, thank you

***You will need to make a deposit into your account before a debit card and/or checks will be ordered for this checking account. Please visit an Illinois State Credit Union near you if you do not authorize a transfer on this form.

What account number and suffix would you like us to use? *

How much would you like to transfer? *

Your overdraft ATM and debit card transactions will be declined if you choose to opt-out of Illinois State Credit Union’s overdraft courtesy pay service.

If you want Illinois State Credit Union to authorize and pay overdrafts on ATM and everyday debit card transactions select Opt-in option in the form below:

(Detailed explanation of your options was provided in the Disclosures section of your online Membership application. If you have any question regarding Illinois State Credit Union’s Overdraft Courtesy Pay Program or your options please call 309-451-8400)

Overdraft Services *

Opt-in: YES, I WANT TO OPT-IN. I want Illinois State Credit Union to authorize and pay overdrafts on my ATM and debit card transactions. I understand a standard fee will apply. Opt-out: I DO NOT want Illinois State Credit Union to authorize and pay overdrafts on my ATM and debit card transactions. I understand that my debit card will be denied if there are not sufficient funds in my account for the transaction.

Would you like to add any beneficiaries to your account? *

Yes No

*Adding beneficiaries on this form will be replace any exisiting beneficiaries that are currently on your regular share account. Before making this change, ALL primary and joint owners need to sign the form below or fill out an additional form listing the same beneificiaries.*

Name of Beneficiary: *

First Name Last Name

Birth Date of Beneficiary: *

Date

Phone Number of Beneficiary: *

- Area Code Phone Number

Social Security Number of Beneficiary:

(Helps us to identify your beneficiary)

Address of Beneficiary:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Do you have additional beneficiaries you want listed on your account? (This will split the money evenly between all named beneficiaries.) *

Yes No

Name of Second Beneficiary: *

First Name Last Name

Birth Date of Second Beneficiary: *

Date

Phone Number of Second Beneficiary: *

- Area Code Phone Number

Social Security Number of Second Beneficiary:

(Helps us to identify your beneficiary)

Address of Second Beneficiary:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Do you have additional beneficiaries you want listed on your account? (This will split the money evenly between all named beneficiaries.) *

Yes No

Name of Third Beneficiary: *

First Name Last Name

Birth Date of Third Beneficiary: *

Date

Phone Number of Third Beneficiary: *

- Area Code Phone Number

Social Security Number of Third Beneficiary:

(This helps us to identify your beneficiary)

Address of Third Beneficiary:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Do you have additional beneficiaries you want listed on your account? (This will split the money evenly between all named beneficiaries.) *

Yes No

Name of Fourth Beneficiary: *

First Name Last Name

Phone Number of Fourth Beneficiary: *

- Area Code Phone Number

Social Security Number of Fourth Beneficiary:

(This helps us to identify your beneficiary)

Address of Fourth Beneficiary

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

How did you hear about this account?

Attach a copy of your ID *

Attach a copy of Joint ID

Signature *

Joint Signature *

Today's Date

- Month - Day Year

Overdraft Opt-In Form