Name: Address: City/State/Zip: Home Phone: Business Phone: Email:

Employer: Art form/Job title: Place of Birth: Date of Birth: Mother's Maiden Name: Soc. Sec. #:

Account Number (assigned by ACFCU):

CONTINUED.......

DESIGNATION OF BENEFICIARY FOR SHARES I/We, ___________________________________________________________________(Name of Account Owner/s) hereby designate _____________________________________________________________ (Name of beneficiary) who resides at ____________________________________________________________ as the beneficiary on Account No. ___________ and as such s/he is entitled to all shares in said account upon my death, or, if there is no more than one owner, upon the death of all the owners. Signed: ______________________ | ______________________ | ______________________ If this is a joint share account, all joint owners must sign the designation to make it valid.

(Instruction to Signer: If you have been notified by the Internal Revenue Service (IRS) that you are subject to backup withholding due to payee underreporting and you have not received a notice from the IRS that the backup withholding has terminated, you must strike out the language in clause 2 of whichever certification you sign below.) CERTIFICATION AS TO TAXPAYER IDENTIFICATION NUMBER AND BACKUP WITHHOLDING Under penalties of perjury, I certify (1) that the number shown on this form is my correct taxpayer identification number and (2) that 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 (IRS) has notified me that I am no longer subject to backup withholding. Signature ___________________________________________ Date ___________________

JOINT SHARE ACCOUNT AGREEMENT (* NOT TRANSFERABLE) The Artists Community Federal Credit Union is hereby authorized to recognize any of the signatures subscribed below in the payment of funds or the transaction of any business for this account. The joint owners of this account hereby agree with each other and with said credit union that all sums now paid in on shares, or heretofore or hereafter paid in on shares by any or all of said joint owners to their credit as such owners with all accumulations thereon, are and shall be owned by them jointly, with right or survivorship and be subject to the withdrawal or receipt of any of them, and payment to any of them or the survivor or survivors shall be valid and discharge said credit union from any liability for such payment. The joint owners also agree to the terms and conditions of the account as established by the credit union from time to time. Any or all of said joint owners may pledge all or any part of the shares in this account as collateral security to a loan or loans from the credit union. The right or authority of the credit union under this agreement shall not be changed or terminated by said owners, or any of them except by written notice to said credit union which shall not affect transactions theretofore made. Joint Account No. ____________________________ Date ______________________ Soc. Sec. #/Tax I.D. # -------------------Joint Owners (each must sign below)------------------------Date of birth ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Consent of Spouse (to be completed in some states if joint owner is other than spose of member) Approved and consented to (signature of spouse):_________________________________ Date: ________ * as defined in 12 CFR Part 204