SHARE CERTIFICATE APPLICATION
NJ GATEWAY FEDERAL CREDIT UNION

P.O. Box 420, Dayton, NJ 08810
Phone 732-329-3838 - Fax 732-329-8624

NJ Gateway Federal Credit Union offers the following certificate terms/ maturities:

3 months $10,000 Minimum Deposit
5 months $1,000 Minimum Deposit
6 months $1,000 Minimum Deposit
1, 2, 3, 4 or 5-year $1,000 Minimum Deposit

All deposits are insured by the National Credit Union Administration up to $100,000.00. Dividend rates are subject to change daily.
Current rates may be obtained by visiting our website at www.njgateway.org, via Call-24, or by calling a Member Service Representative at 732-329-3838.
Please complete all of the information below to establish a certificate account. Please return the form along with your deposit information either by mail or by fax. (See above info) A certificate will be issued and mailed to you upon establishment of the account.

NAME: ACCOUNT NUMBER:
STREET ADDRESS: SOCIAL SECURITY NUMBER:
CITY, STATE, ZIP: HOME PHONE: (            )
JOINT NAME: ACCOUNT NUMBER:
STREET ADDRESS: SOCIAL SECURITY NUMBER:
CITY, STATE, ZIP HOME PHONE: (        )

I would like to purchase a certificate in the amount of $______________ (whole dollars) for the term of:
__ 3-months   __ 6 months   __ 1-year  __ 2-year  __ 3-year  __ 4-year  __ 5-year

My deposit is:  __ enclosed      __to be transferred from account number: ______________________

I would like the dividends to be paid in the following manner:  __ Rollover (deposit back to the certificate account)  __ Deposited directly to my share savings account

I/We certify that the information on this application is true and accurate as of the date indicated by my/our signature below. I/We certify that I/we have provided correct tax payer identification number(s) and that I/we are not subject to backup withholding taxes as a result of a failure to report all interest or dividends. I/We certify that I/we have not been notified by the Internal Revenue Service or any other governmental agency of such. I/We have been provided a fee disclosure and rate schedule and I/we have read the information. By signing this application, I/we agree to abide by all terms and conditions described within the disclosures as well as provided on the certificate.

Member Signature __________________________ Date __________    

Joint Signature ____________________________  Date__________