Application Attestation

IMPORTANT: I/We understand that this Membership Application/Account Card governs all accounts opened on the date referenced above, and new Certificate Accounts only (non-IRA) opened hereafter. By signing this Membership Application/Account Card, I/we agree that VyStar Credit Union may rely on this Membership Application/Account Card for establishing and determining account ownership and beneficiary designation for the accounts listed and for any new Certificate Accounts (only) opened hereafter. If there is a change in account ownership or beneficiary, I/we understand that a new Membership Application/Account Card, or any form as designated by VyStar Credit Union, may be required.

CERTIFICATION: I/We hereby make application for membership in the VyStar Credit Union and agree: (A) to conform to its bylaws and any amendments thereof; (B) to subscribe for at least one (1) share; (C) that the account is subject to the payment of fees adopted from time-to-time by VyStar Credit Union; and (D) (jointly and severally if more than one) that this account is and shall be governed by the terms and conditions set forth in the “Membership Booklet” described below, as may be amended from time-to-time. I further certify that I am in the VyStar Credit Union field of membership. I/We understand that VyStar Credit Union has published a booklet entitled “Membership Booklet”. I/We acknowledge that VyStar’s Membership Booklet, Rate Information, and Fee Schedule has been or will be furnished to me/us by VyStar Credit Union. I/we further agree that if I/we do not receive the Membership Booklet, I/we will notify VyStar Credit Union and request my/our copy. By my/our signature below, I/we hereby certify that I/we are eligible for membership by the county I/we live or work, have a family member who is a member of VyStar Credit Union, or who is eligible for membership, have an immediate family member who is an active duty, reservist and retired/veteran/annuitant military personnel, as well as civilian employees, from all branches of the armed forces, or am a employee or client of Brightway. I/we hereby authorize VyStar Credit Union to obtain all credit reports or other credit information on me/us in connection with the opening of this or any other account, obtaining a Debit Card or obtaining any other loan product. If the Membership Application/Account Card is not signed in the presence of a VyStar employee, the notary section to the right of this form must be completed and signed by a notary.

Substitute Form W-9. Certification: By signing below, under penalties of perjury I/we certify (1) that the taxpayer identification number shown on this form is my/ our correct identification number; (2) that I (we) am/are not subject to backup withholding either because I/we have not been notified that I (we) am/are 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 (we) am/are no longer subject to backup withholding; and (3) that I (we) am/are a United States person or United States resident alien. If you have been notified by the IRS that you are subject to back up withholding due to payee underreporting and have not been notified by the IRS that the backup withholding is terminated, you should strike out the language in clause two of the above certification statement before you sign this application. The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. (4) The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. (Not Applicable)