Certificate Account Instructions Form

You can use this form to:

Make a certificate account dividends withdrawal
Close a certificate account now or when the certificate account matures
Reinvest your funds in a new certificate account when your current certificate account matures

Please do not use any dollar signs ($) when submitting dollar values on the form.

Member Information

First Name *

Last Name *

Email *

Daytime Phone *

Last Four digits of Social Security Number *

Date of Birth *

I would like to *

Certificate Account Dividends Withdrawal ONLY

Member Account Number *

Certificate Account Share ID *

Transfer Amount *

To Member Account Number *

Share ID *

Notes and Comments

IMPORTANT INFORMATION ABOUT THE PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask you for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

Understanding My Maturity Date

HVCU certificate accounts have a 10-day grace period after their renewal/maturity date. Please enter a maturity date for your certificate account based on the following:

If your certificate account has not yet matured, enter the maturity date of the certificate account.
If you are within the 10-day grace period for a certificate account that has matured, enter the anticipated maturity date for your new certificate account. For example, if today is September 1, 2023 and you want to open a 12-month certificate account, enter September 1, 2024 for your maturity date.

Certificate Account Instructions Form

Member Information