SHARE CERTIFICATE APPLICATION
NJ GATEWAY FEDERAL CREDIT UNION

P.O. Box 420, Dayton, NJ 08810
Phone 732-329-3838 - Fax 732-329-8624

NJ Gateway Federal Credit Union offers the following certificate terms/ maturities:

3 months $10,000 Minimum Deposit
5 months $1,000 Minimum Deposit
6 months $1,000 Minimum Deposit
1, 2, 3, 4 or 5-year $1,000 Minimum Deposit

All deposits are insured by the National Credit Union Administration up to $250,000.00.  Dividend rates are subject to change daily.
Current rates may be obtained by visiting our website at www.njgateway.org, via Call-24, or by calling a Member Service Representative at 732-329-3838.
Please complete all of the information below to establish a certificate account. Please return the form along with your deposit information either by mail or by fax. (See above info) A certificate will be issued and mailed to you upon establishment of the account.

NAME: ACCOUNT NUMBER:
STREET ADDRESS: SOCIAL SECURITY NUMBER:
CITY, STATE, ZIP: HOME PHONE: (            )
JOINT NAME: ACCOUNT NUMBER:
STREET ADDRESS: SOCIAL SECURITY NUMBER:
CITY, STATE, ZIP HOME PHONE: (        )

Important Information About Opening Your Account at  NJ Gateway Federal Credit Union 

(USA Patriot Act Sec. 326)

Federal Law requires that all financial institutions obtain, verify and record information that identifies each person who opens an account. Therefore, when you open an account, we will ask for your name, address, date of birth and other information that will enable us to identify you. We may also ask to see your government issued identification or other identifying documents. NJ Gateway FCU is committed to preserving and protecting the confidentiality of its members' personal information. The credit union will maintain strong security controls to ensure that personal member information is protected from unauthorized use.

I would like to purchase a certificate in the amount of $______________ (whole dollars) for the term of:
__ 3-months   __ 6 months   __ 1-year  __ 2-year  __ 3-year  __ 4-year  __ 5-year

My deposit is:  __ enclosed      __to be transferred from account number: ______________________

I would like the dividends to be paid in the following manner:  __ Rollover (deposit back to the certificate account)  __ Deposited directly to my share savings account

I/We certify that the information on this application is true and accurate as of the date indicated by my/our signature below. I/We certify that I/we have provided correct tax payer identification number(s) and that I/we are not subject to backup withholding taxes as a result of a failure to report all interest or dividends. I/We certify that I/we have not been notified by the Internal Revenue Service or any other governmental agency of such. I/We have been provided a fee disclosure and rate schedule and I/we have read the information. By signing this application, I/we agree to abide by all terms and conditions described within the disclosures as well as provided on the certificate.

Member Signature __________________________ Date __________    

Joint Signature ____________________________  Date__________