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Get Wawa Application Online

WAWA EMPLOYEES CREDIT UNION 260 W. Baltimore Pike Wawa PA 19063-5699 610-358-8030 MEMBERSHIP APPLICATION Name Please Print Last First Middle Initial Street City State Zip Social Security Number Date of Birth Home Phone Work Phone 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 Signature Date Over 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 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. Official Use Only Joint Members Signature Savings Joint Account Information Only Check the services you would like to receive. 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 Signature Date Over 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 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. 3 I am a U*S* person including a U*S* resident alien. Your Signature Date Over 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 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. Official Use Only Joint Members Signature Savings Joint Account Information Only Check the services you would like to receive. 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 Signature Date Over 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 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. Official Use Only Joint Members Signature Savings Joint Account Information Only Check the services you would like to receive.

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