NJ Gateway Share Certificate Order Form

SHARE CERTIFICATE APPLICATION - Special Terms & Rates

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

186 Days	Special 4.5% A.P.Y.*	$1,000 Minimum Deposit
Must be opened with new funds only. At maturity certificate will automatically rollover to NJ Gateway’s existing 6-month certificate rate and promotional term.
99 Days	Special 4.25% A.P.Y.*	$1,000 Minimum Deposit
May be opened with new funds or funds already on deposit with NJ Gateway FCU. At maturity certificate will automatically rollover to NJ Gateway’s existing 3-month certificate rate and promotional term.

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 186 Days at 4.5% APY*

___ I would like to purchase a certificate in the amount of $______________ (whole dollars) for the term of 99 Days at 4.25% APY*

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.