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Submit an Online Membership Application
This form is currently NOT OPERATIONAL due to system upgrades. We hope to have it operational again soon. If you need assistance, please contact the BrightStar Credit Union Member Service Center at 954-486-2728 or 800-637-2728.  We apologize for any inconvenience.
Check service requested OPEN NEW ACCOUNT(S)
CHANGE EXISTING ACCOUNT(S)
Existing Account Number:
( Required for existing accounts)


This form will supersede any others on file.
1. PRIMARY MEMBER INFORMATION
First Name:*
 Last Name:*
 Initial
Date of Birth:*
Mailing Address:*
City:*
 State:*
 Zip:*
Permanent Address (if different):
City:
 State:
 Zip:
SSN:*
 Drivers License#:*
 State:*
Home Phone:*
 Work Phone:
  
Email Address:
 Mother's Maiden Name:*
  
Employer:
 Department/Location:
 Are you a U.S. Citizen?*
Yes   No
How did you hear about us?
Presentation at my employer Event or conference
Friend or family member Drove by branch Online Phonebook
Direct mail Newspaper TV Radio Outdoor ad Dealership Other:
2. SOURCE OF ELIGIBILITY FOR MEMBERSHIP*
I live I work in: Broward County Palm Beach County
I am related to someone eligible for membership.
      Print Name, Relationship
Organization within Broward County of Palm Beach County
Other (please explain)
3. JOINT OWNER(S) - Optional
Joint Owner Last Name:
 First:
 Initial:
SSN:
 DOB:
Drivers License#:
 State:
Joint Owner Last Name:
 First:
 Initial:
SSN:
 DOB:
Drivers License#:
 State:
4. CHOOSE YOUR ACCOUNTS
Check each account or service you are requesting from BrightStar Credit Union. Please indicate if account is to be held individually (by you alone) or in joint tenancy (with the above named joint owner(s), if any).
    Individual Account Joint Account Name(s), if joint account
BrightStar CU Membership (Savings)
Checking Account
Money Market Account
Wish Account
Visa Check Card
ATM Card
Free Online Banking and Call24*    
Other
Online Banking Transfer Setup (Optional)
I would like to transfer funds with Call24 and BrightStar CU Online Banking to another member account. I authorize BrightStar CU to honor and process transactions to the following member number(s). INITIAL PRINTED FORM HERE
Name
 Member #
 Account Type
Name
 Member #
 Account Type
*A BrightStar CU Online password will be assigned to you at the time we receive your application.
5. BENEFICIARY - DESIGNATION OF PAY ON DEATH (POD) BENEFICIARY (INDIVIDUAL ACCOUNTS) OR PAY ON DEATH (POD) PAYEES (JOINT ACCOUNTS)
If I have requested an individual account(s), then the party(s) listed below will be considered my Pay on Death (POD) beneficiary(s) and if they survive me they will receive any unencumbered amounts in my Credit Union account(s) after my death. If I have requested a joint account with another party, then the party(s) listed below will be considered my Pay on Death (POD) payee(s). Upon the death of the last surviving account owner, the unencumbered funds shall be paid out equally to the surviving POD payees.
 
Last Name
 First
 Initial
 SSN
Mailing Address:
City
 State
 Zip
  
 
Last Name
 First
 Initial
 SSN
Mailing Address:
City
 State
 Zip
  
ssssss
6. BACKUP WITHHOLDING INFORMATION
TAXPAYER IDENTIFICATION NUMBER (TIN); Under penalties of perjury, I certify (1) that the Taxpayer Identification Number (TIN) shown on this form is my correct TIN and (2) that I am not subject to backup withholding (unless I have stated below that I am 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 has notified me that I am no longer subject to backup withholding.
I am subject to backup withholding I am NOT a United States citizen or U.S. Person, including a U.S. resident alien (complete a W-8 Certificate of Foreign Status.)
7. SUBMITTING:

PLEASE READ CAREFULLY BEFORE SUBMITTING:

View and Print our account disclosures »


If Primary Member: By affixing my signature hereunder, I hereby make application for membership in BrightStar Credit Union and agree to be bound by all of its terms and conditions of membership, including, but not limited to, those contained in the separate BrightStar CU disclosure, and any amendments thereto, or those contained in any Member Agreement and Disclosure provided to me at any time are fully incorporated herein. Members must have a valid social security number or tax identification number.

If Joint Owner: By affixing my signature hereunder, I agree to conform to the terms and conditions of joint ownership of BrightStar CU and understand that the designation of joint owner on an account does not constitute membership in BrightStar CU. (Joint owners must be 18 years of age or older and have their own social security number or tax identification number). By signing, the joint owner agrees to promptly notify the Credit Union of the death of the primary member. I/we hereby certify that the information on this Member Application is true and correct, BrightStar CU is authorized to make whatever inquiries it deems necessary of others concerning the information I/we have provided to the Credit Union on this application, including, but not limited to, obtaining investigative consumer reports from consumer reporting agencies regarding my/our character, personal characteristics, and general reputation, as authorized by applicable law, and to provide information arising out of my/our transactions with BrightStar CU to credit reporting agencies.

I/we understand and agree that if I/we owe the Credit Union any money now or in the future, the Credit Union shall have the right to setoff against any of my/our accounts with the Credit Union, and to apply such funds to satisfy all liabilities (as defined hereinafter) of mine/ours or any other joint owner regardless of whom deposited the funds, and regardless of the source of such funds. "Liabilities" means and includes all indebtedness and obligations of any account owner for borrowed money, service charges, fees, or a judgment debt. I/we understand that this account is established and operates subject to applicable Federal and State laws. I/we have read the application agreements and membership application disclosure statements above and agree to be bound to the terms and conditions and any amendments of those agreements and disclosures. I/we certify that the information given on this application is complete and true and submitted for the purpose of obtaining credit and Credit Union membership. I/we agree that any dispute relating to this account will be resolved in accordance with the arbitration provisions contained in the separate BrightStar CU terms and conditions disclosure.

FOR MINOR ACCOUNTS ONLY: I give my child permission to withdraw from his/her Savings Account. I understand that by signing in this box my child will be able to withdraw funds from his/hers Savings Account at any time without my knowledge.   SIGN PRINTED FORM HERE

Federal law requires us to obtain, verify and record information that identifies each person who opens an account. Questions? Call 954-486-2728.


* indicates required information

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