Coverdell Education Savings Account (ESA) Form

Personal Information

Are you a new member? *

Yes

No

Your Full Name *

Home Phone *

Daytime Phone

Email *

Address Information

Residential Address *

City *

State *

Zip *

Contact Preferences

Preferred Location? *

Independence Main Branch

Raytown Branch

St Joseph Branch

Olathe Branch

Contact Preference? *

Phone

Mail

Email

Preferred Time? *

Morning

Lunchtime

Afternoon

Residential Address for Mailings? *

Yes

No

Joint Account Information

Number of Joint Owners on this Account? *

0

1

2

Comments

NOTICE: United Consumers CU reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, you grant full permission to do so.

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Name

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Personal Information

Address Information

Contact Preferences

Joint Account Information

Comments