Taxpayer Identification Number Certification

The Social Security Number(s) shown above is my correct SSN.

I am not subject to backup withholding either because I have not been notified that I am 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.

I am an exempt recipient under the Internal Revenue Service Regulations.

I am not a United States person, or if I am an individual, I am neither a citizen nor a resident of the United States.

I certify under penalties of perjury the statements checked in this section are true.

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I authorize Connex Credit Union to obtain a copy of my current credit report as a condition of acceptance of this application and for the purpose of extension of or renewal of credit.

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I would like to access this account through Online Banking.

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I have a Your Choice Checking Account at Connex