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Includes sections for primary applicant information, joint applicant information and survivorship designation, beneficiary details, account funding choices, and eligibility requirements tied to Mecklenburg County or specified employers/family membership. Also includes US Patriot Act identity verification language and TIN certification/backup withholding declaration for federal tax purposes.","Membership Application  \n\n| Account Ownership |\n| --- |\n| o Individual o Joint o Minor with Joint |\n\nEmail, mail or deliver application and identity documents to:  \n2000 Continental Blvd., Charlotte, NC 28273 [memberservice@blueflamecu.org](memberservice@blueflamecu.org)  \n| Requested Accounts |  |  |  | Requested Services | Loan Interests |\n| --- | --- | --- | --- | --- | --- |\n| x | Savings Account | o | IRA/Education Account | o Online Banking | o Mastercard Credit Card |\n| o | Checking Account | o | IRA/Education Certificate | o eStatements | o Auto Loan Refinance |\n| o | Vacation Account | o | Certificate | o Paper Statements (see fee schedule) | o Debt Consolidation |\n| o | Christmas Account | o | Youth Certificate | o ATM/Debit Card | o New Loan or Mortgage |\n| o | Money Market | o | Additional Savings Account | o Checks |  |\n\n\n| Primary Applicant Information |  |  |  |\n| --- | --- | --- | --- |\n|  |  |  |  |\n| First Name Middle Name Last Name |  | Social Security Number | Date of Birth |\n| Street Address |  | City | State & Zip Code |\n| Mailing Address (if different) |  | City | State & Zip Code |\n| Occupation |  | Place of Employment | Driver’s License \\# /State/Exp. Date |\n| Home Phone | Cell Phone | Work Phone | Email Address |\n| Membership Eligibility: o I live, work, worship or attend school in Mecklenburg County. o I am an employee/retiree of Duke Energy or Piedmont Natural Gas.\u003Cbr>o I am an immediate family member of a Blue Flame member. o I am an employee/retiree of Heritage Propane or Amerigas. Name of Organization or Family Member: |  |  |  |\n\n\n| Joint Applicant Information |  |  |  |\n| --- | --- | --- | --- |\n|  |  |  |  |\n| Joint Applicant \\#1 Name (First, Middle, Last) |  | Social Security Number | Date of Birth |\n| Street Address |  | City | State & Zip Code |\n| Occupation |  | Place of Employment | Driver’s License \\# /State/Exp. Date |\n| Home Phone | Cell Phone | Work Phone | Email Address |\n| Joint Applicant \\#2 Name (First, Middle, Last) |  | Social Security Number | Date of Birth |\n| Street Address |  | City | State & Zip Code |\n| Occupation |  | Place of Employment | Driver’s License \\# /State/Exp. Date |\n| Home Phone | Cell Phone | Work Phone | Email Address |\n| Right of Survivorship Designation for Joint Accounts: We understand that by establishing a joint account under the provisions of North Carolina General Statute 54-109.58 that: (1) the Credit Union may pay the money in the account to, or on the order of, any person named in the account unless we have directed that withdrawals require more than one signature; and (2) if we elect to create the right of survivorship in the account, that upon the death of one joint owner the money remaining in the account will belong to the surviving joint owners and will not pass by inheritance to heirs of the deceased joint owner or be controlled by the deceased joint owner’s will.\u003Cbr>We would like this account to be: o With Survivorship o Without Survivorship |  |  |  |\n\nYes No  \n1. Will you use this account as your primary savings or checking account? o o If no, what is the account purpose?   \n2. Will you send/receive money to/from anyone outside the U.S.? o o If yes, which foreign country?    \n3. Will you deposit or withdraw over $5,000 in cash on a regular basis? o o If yes, how frequently?    \n4. Do you plan to use our online banking/bill payment services? o o  \n5. Will you receive direct deposits from other than payroll, retirement, or government agencies? o o If yes, what sources?   Note: first order checks will include accountholder(s) name(s) and mailing address; check reorders can be done online at [blueflamecu.org/reorder](blueflamecu.org/reorder)  \n| Beneficiary \\#1 |  | Beneficiary \\#2 |  |\n| --- | --- | --- | --- |\n|  |  |  |  |\n| Name | % of Beneficiary | Name | % of Beneficiary |\n| Social Security Number | Date of Birth | Social Security Number | Date of Birth |\n| Street Address |  | Street Address |  |\n| City | State & Zip Code | City | State ","cbCaic6WFiPDZXEb","https://ap.wps.com/l/cbCaic6WFiPDZXEb","pdf",467235,1,2,"English","en",105,"# Membership Application\n## Account Ownership and Requested Services\n## Primary Applicant Information\n## Joint Applicant Information\n## Survivorship, Questions, and Eligibility\n## Beneficiaries and Account Funding\n## US Patriot Act\n## TIN Certification and Backup Withholding","[{\"question\":\"What information is required for the primary applicant?\",\"answer\":\"The form requests first/middle/last name, Social Security number, date of birth, street and mailing addresses, occupation and employer, driver’s license details, phone numbers, and email address.\"},{\"question\":\"How does the form handle joint accounts and survivorship?\",\"answer\":\"It collects joint applicant information for up to two people and asks whether survivorship is included. It explains how funds may be paid to named joint owners and how remaining funds pass to the surviving joint owners upon death.\"},{\"question\":\"What is included in the TIN certification and backup withholding section?\",\"answer\":\"The applicant certifies the taxpayer identification number, statements about whether backup withholding applies, and whether the applicant is a U.S. citizen or other U.S. person for federal tax purposes.\"}]","Blue Flame Membership Application - Account, Services, and TIN Certification Form | PDF",1787706075,5,{"code":4,"msg":31,"data":32},"ok",{"site_id":24,"language":23,"slug":33,"title":13,"keywords":34,"description":14,"schema_data":35,"social_meta":85,"head_meta":87,"extra_data":89,"updated_unix":28},"blue-flame-membership-application-account-services-and-tin-certification-form","",{"@graph":36,"@context":84},[37,53,67],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,47,50],{"item":41,"name":42,"@type":43,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":21},"https://docshare.wps.com/document/","Document",{"item":48,"name":12,"@type":43,"position":49},"https://docshare.wps.com/document/healthcare/",3,{"item":51,"name":13,"@type":43,"position":52},"https://docshare.wps.com/document/blue-flame-membership-application-account-services-and-tin-certification-form/144622/",4,{"url":51,"name":13,"@type":54,"author":55,"headline":13,"publisher":57,"fileFormat":60,"inLanguage":23,"description":14,"dateModified":61,"datePublished":61,"encodingFormat":60,"isAccessibleForFree":62,"interactionStatistic":63},"DigitalDocument",{"name":9,"@type":56},"Person",{"url":41,"name":58,"@type":59},"DocShare","Organization","application/pdf","2026-08-26",true,{"@type":64,"interactionType":65,"userInteractionCount":4},"InteractionCounter",{"@type":66},"ViewAction",{"@type":68,"mainEntity":69},"FAQPage",[70,76,80],{"name":71,"@type":72,"acceptedAnswer":73},"What information is required for the primary applicant?","Question",{"text":74,"@type":75},"The form requests first/middle/last name, Social Security number, date of birth, street and mailing addresses, occupation and employer, driver’s license details, phone numbers, and email address.","Answer",{"name":77,"@type":72,"acceptedAnswer":78},"How does the form handle joint accounts and survivorship?",{"text":79,"@type":75},"It collects joint applicant information for up to two people and asks whether survivorship is included. 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