Super Smart Checking Account Request Form

Super Smart All-Electronic Checking Account Request Form

First Name *

Last Name *

Phone *

Email *

I am the primary owner of the account

Order a debit card for me

Add the joint owner(s) on my savings account as the joint owner(s) on my checking account

Joint Owner 1 Full Name

Joint Owner 1 Email

Joint Owner 2 Full Name

Joint Owner 2 Email

Order a debit card for my joint owner(s)

SPECIFIC TERMS APPLICABLE TO YOUR SUPER SMART CHECKING ACCOUNT Tiered Fixed Rate Information. This Account is subject to a Tiered Fixed Rate. For the current dividend rate and corresponding APY, refer to the accompanying Account Disclosure Rate Supplement which We have included with and made a part of this Disclosure. Minimum Balance Requirements. To obtain the disclosed annual percentage yield, You must maintain an average daily balance at least equal to $0.01 in Your Account during each dividend period. Transaction Limitations. This is a totally electronic transactional account. There will be a fee assessed for each teller/employee assisted transaction and for each check that attempts to or does clear Your Account. Additional Information. In order to earn dividends at the disclosed rate, during each dividend period You must: (a) make at least $1,000 in direct deposit(s) to Your Account; and (b) make 20 or more point of sale credit transactions (evidenced by Your statement) using Your Debit Card; and (c) consent to receive Your periodic statements and notices electronically. You will be charged a $4.95 monthly fee if you don’t meet the required criteria.

By submitting this form I request Public Service Credit Union to open a checking and/or debit card(s) on my account based on my selection above. I agree to the terms and conditions listed above and those contained within the Truth in Savings disclosure.

TRUTH IN SAVINGS DISCLOSURE

Thank you for requesting to open a checking account with PSCU. Someone will contact you to complete the process and answer any questions you may have.