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(Attach a separate application for each group included in your
request for
1. Name and address of credit union:
2. Name of group/association to be added:
(If Association, include Charter/Bylaws.)
Description of Business:
Address:
3. Total number of potential employees/members to be added:
Sponsor's headquarters location:
If relevant, work and/or paid from location. Also indicate number of employees at each location:
4. Distance to nearest credit union service facility group has access to:
5. Is the group eligible for membership in any other credit union?
No
Yes
If yes, give the name and location of other servicing credit union. Also include, if applicable, a letter of release from the overlapped credit union.
6. Attach a letter, on letterhead stationery if possible, from the group requesting credit union service.
The Commissioner may request other documentation appropriate to the situation. This may include current financial statements, branch office financial statements, or other data.
Other comments:
Name and title of credit union board-authorized representative: (e.g., Credit Union manager/President/CEO--Please print or type)
Signature Date
