Business Account Application

Business Account

Becoming a member is easy! If your business has operations in Wyoming you are eligible to join Atlantic City FCU.

• • My business has operations in Wyoming
  OK My business has operations in Wyoming is required
• • By checking this box, I understand that I must open and maintain a business share account with a minimum balance of $25 and a one-time $5 membership fee as a requirement for membership.
  OK By checking this box, I understand that I must open and maintain a business share account with a minimum balance of $25 and a one-time $5 membership fee as a requirement for membership. is required

• Please select any products and services that you would like for this account

  • Checking Account
  • Debit Card
  • Online Banking and Remote Deposit
  • Audio Response
  • E-statement – opt-out
  Optional OK Please select any products and services that you would like for this account is required
• Enter your desired user name – minimum 6 characters
  OK Enter your desired user name – minimum 6 characters is required
• Enter your desired password – minimum 10 characters, must contain at least one digit and one special character
  OK Enter your desired password – minimum 10 characters, must contain at least one digit and one special character is required

Demographic Information for your Business

• Name of Business
  OK Name of Business is required
• Is this a DBA? NoYes
  OK Is this a DBA? is required
• Individual Owner First Name
  OK Individual Owner First Name is required
• Individual Owner Last Name
  OK Individual Owner Last Name is required
• Individual Owner Middle Name
  Optional OK Individual Owner Middle Name is required

• Entity Type

  • Corporation
  • DBA
  • Non-profit
  • Partnership
  • Sole Proprietorship
  OK Entity Type is required
• Email Address
  OK Email Address is required
• Date of Business Establishment
  Optional OK Date of Business Establishment is required
• Phone Number
  OK Phone Number is required
• EIN number or SSN for a DBA
  OK EIN number or SSN for a DBA is required
• Physical Business Address
  OK Physical Business Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required
• Is Mailing Address Different? NoYes
  OK Is Mailing Address Different? is required
• Mailing Address
  OK Mailing Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required

Authorized Signers

• First Name
  OK First Name is required
• Middle Name
  Optional OK Middle Name is required
• Last Name
  OK Last Name is required
• Email Address
  OK Email Address is required
• Date of Birth
  OK Date of Birth is required
• Social Security Number
  OK Social Security Number is required
• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required
• Would you like to add another authorized signer? NoYes
  OK Would you like to add another authorized signer? is required

Authorized User 1

• First Name
  OK First Name is required
• Middle Name
  Optional OK Middle Name is required
• Last Name
  OK Last Name is required
• Email Address
  OK Email Address is required
• Phone Number
  OK Phone Number is required
• Date of Birth
  OK Date of Birth is required
• Social Security Number
  OK Social Security Number is required
• Physical Address
  OK Physical Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required
• Is Mailing Address Different? NoYes
  OK Is Mailing Address Different? is required
• Mailing Address
  OK Mailing Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required
• Would you like to add another authorized signer? NoYes
  OK Would you like to add another authorized signer? is required

Authorized User 2

• First Name
  OK First Name is required
• Middle Name
  Optional OK Middle Name is required
• Last Name
  OK Last Name is required
• Email Address
  OK Email Address is required
• Date Of Birth
  OK Date Of Birth is required
• Phone Number
  OK Phone Number is required
• Social Security Number
  OK Social Security Number is required
• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required
• Would you like to add another authorized signer? NoYes
  OK Would you like to add another authorized signer? is required

Authorized User 3

• First Name
  OK First Name is required
• Middle Name
  Optional OK Middle Name is required
• Last Name
  OK Last Name is required
• Email Address
  OK Email Address is required
• Phone Number
  OK Phone Number is required
• Date of Birth
  OK Date of Birth is required
• Social Security Number
  OK Social Security Number is required
• Physical Address
  OK Physical Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required
• Would you like to add another authorized signer? NoYes
  OK Would you like to add another authorized signer? is required

Authorized User 4

• First Name
  OK First Name is required
• Middle Name
  Optional OK Middle Name is required
• Last Name
  OK Last Name is required
• Email Address
  OK Email Address is required
• Date Of Birth
  OK Date Of Birth is required
• Social Security Number
  OK Social Security Number is required
• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required

Certification of Beneficial Owners

• • Check this box if you are the individual filling out this form
  Optional OK Check this box if you are the individual filling out this form is required
• First Name of the individual filing out this form
  OK First Name of the individual filing out this form is required
• Middle Name of the individual filing out this form
  Optional OK Middle Name of the individual filing out this form is required
• Last Name of the individual filing out this form
  OK Last Name of the individual filing out this form is required

• Do you own 25% of more of the business or have significant responsibility for managing or directing the entity?

  • No
  • Yes
  OK Do you own 25% of more of the business or have significant responsibility for managing or directing the entity? is required
• Are there any other individuals with 25% or more ownership or has significant responsibility for managing or directing the entity (e.g. – CEO, CFO, COO, Managing Member, General Partner, etc.). These individuals are not authorized signers. NoYes
  OK Are there any other individuals with 25% or more ownership or has significant responsibility for managing or directing the entity (e.g. – CEO, CFO, COO, Managing Member, General Partner, etc.). These individuals are not authorized signers. is required

Beneficial Owners 2

• First Name
  OK First Name is required
• Middle Name
  Optional OK Middle Name is required
• Last Name
  OK Last Name is required
• Email Address
  OK Email Address is required
• Phone
  OK Phone is required
• Date of Birth
  OK Date of Birth is required
• Social Security Number
  OK Social Security Number is required
• Address
  OK Address is required
• Cityy
  OK Cityy is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required
• Are there any other individuals with 25% or more ownership or has significant responsibility for managing or directing the entity (e.g. – CEO, CFO, COO, Managing Member, General Partner, etc.). These individuals are not authorized signers. NoYes
  OK Are there any other individuals with 25% or more ownership or has significant responsibility for managing or directing the entity (e.g. – CEO, CFO, COO, Managing Member, General Partner, etc.). These individuals are not authorized signers. is required

Beneficial Owners 3

• First Name
  OK First Name is required
• Middle Name
  Optional OK Middle Name is required
• Last Name
  OK Last Name is required
• Email Address
  OK Email Address is required
• Phone Number
  OK Phone Number is required
• Date of Birth
  OK Date of Birth is required
• Social Security Number
  OK Social Security Number is required
• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required
• Are there any other individuals with 25% or more ownership or has significant responsibility for managing or directing the entity (e.g. – CEO, CFO, COO, Managing Member, General Partner, etc.). These individuals are not authorized signers. NoYes
  OK Are there any other individuals with 25% or more ownership or has significant responsibility for managing or directing the entity (e.g. – CEO, CFO, COO, Managing Member, General Partner, etc.). These individuals are not authorized signers. is required

Beneficial Owners 4

• First Name
  OK First Name is required
• Middle Name
  Optional OK Middle Name is required
• Last Name
  OK Last Name is required
• Email Address
  OK Email Address is required
• Phone Number
  OK Phone Number is required
• Date Of Birth
  OK Date Of Birth is required
• Social Security Number
  OK Social Security Number is required
• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required

• • I, hereby certify, to the best of my knowledge, that the information provided above is complete and correct
  OK I, hereby certify, to the best of my knowledge, that the information provided above is complete and correct is required