The field of membership will be made up of employees of the Texas Department of Transportation in the Abilene and Odessa districts, State Division of Motor Vehicles, Department of Public Safety living and working in the Abilene and Odessa district counties and the Taylor County Sheriff's Department and all State agencies within ten miles of the Credit Union office. All retired employees of state agencies mentioned and their families and employees of the Credit Union are also included in the field of membership. Family member being defined as spouse, parents, parents of spouse, children, stepchildren, grandchildren, step-grandchildren, brothers and sisters. All others requesting membership will be considered by the Membership Committee.

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TxDot FCU Member Application

Qualification for membership *

Will this be a Single or Joint Application?

Single Application

Joint Application

First Name*

Last Name*

Email*

Phone (Best contact phone #)*

No dashes, spaces, or parentheses

Social Security No.*

No dashes, spaces, or parentheses

Driver's License No.*

No dashes, spaces, or parentheses

Driver's License State *

Date of Birth *

Address *

Address 2

City *

State *

Zip Code *

Employment information

Current Employer *

Position *

Employee Start Date *

Beneficiary

Beneficiary cannot be a signer on the account.

Full Name*

Present Address*

Address 2

City*

State*

Zip Code*

Social Security Number

Disclosure and Agreement to Terms

I hereby certify that all information contained in the application is furnished for the purpose of obtaining the loan requested herein and is true to the best of my knowledge and belief. I further certify that no consideration has passed or will pass from me, as borrower, to an endorser for his endorsement or to co-maker for his/her signature. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. I have assisted the Credit Union in the preparation of this application; I have provided the Credit Union with all of the information contained therein; I hereby certify that this loan application is truthful and complete to the best of my knowledge and that I have read the entire completed application before signing same.

Do you agree with the above terms and conditions? *

Yes, I agree to the terms

No, I do not agree to the terms

Signature (type your full name) *

Date *

Joint Applicant - Personal information

First Name*

Last Name*

Email*

Phone (Best contact phone #)*

No dashes, spaces, or parentheses

Social Security No.*

No dashes, spaces, or parentheses

Driver's License No.*

No dashes, spaces, or parentheses

Driver's License State *

Date of Birth *

Address *

Address 2

City *

State *

Zip Code *

Employment information

Current Employer *

Position *

Annual Income *

Employee Start Date *

Co-Applicant

Do you agree with the above terms and conditions? *

Yes, I agree to the terms

No, I do not agree to the terms

Signature (type your full name) *

Date *

TxDot FCU Member Application

Employment information

Beneficiary

Disclosure and Agreement to Terms

Joint Applicant - Personal information

Employment information

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