Wawa Application – Fill Out and Use This PDF

WAWA EMPLOYEES’ CREDIT UNION

260 W. Baltimore Pike, Wawa, PA 19063-5699

610-358-8030

MEMBERSHIP APPLICATION

_____________________________________

Name (Please Print) LastFirstMiddle Initial

________________________________________________________

Street

_______________________________________________________

(_____)____________ (____)___________

Email__________________________________________________

_______________________________________________________

Store # or Relationship / Eligibility for Membership

I hereby make application for membership in Wawa

Employees’ Credit Union and agree to conform to the bylaws or any amendments thereof in the Wawa Employees’ Credit

Union. I understand that by my signature on this application, I and any joint owners acknowledge that I have received all applicable disclosures and that I agree to all the terms and conditions as set forth.

Under penalties of perjury I certify that (1) the number shown on this form is my correct Taxpayer Identification (Social Security) Number and (2) that I am not subject to backup withholding as a result of a failure to report all interest or dividends; or the Internal Revenue Service has notified me that I am no longer subject to backup withholding. (3) I am a U.S. person (including a U.S. resident alien).

__________________________________________________

Your SignatureDate

Joint Account Information Only

_____________________________________

___________________________________________________

Check the services you would like to receive.

Savings

 STAR/ATM (Service Fee Charged)

PIN ___ ___ ___ ___

(4 Numbers or 4 Characters no Q or Z)



No fee Checking

Order checks (Cost is deducted from acct)

 Master Card Check Card with

STAR/ATM (Service Fee Charged)

PIN ___ ___ ___ ___

(4 Numbers or 4 Characters no Q or Z)



Christmas Club

Vacation Club



Wawa Payroll Deduction

If you wish your payroll deduction to go into more than one account, fill in the amount on each account and write REMAINDER or NET in the account to receive the balance.

$ _____________ Savings

$ _____________ Checking

$ _____________ Christmas Club

$ _____________ Vacation Club

$ _____________ Total or  Net Pay

____________________________________________________

Official Use Only

Cks System ______ Denial Mailed ______

Cks Date ________________ By________

Disclosure Date ___________By________

ATM Date ______________ By________