PLEASE PRINT THIS APPLICATION.  This is an application of the credit union
named below to add the following named select group to its field of membership.  The application
form must be completed fully or it will be returned to the credit union for completion and resubmission. 
The Division reserves the right to request additional information relating to the field of membership
expansion, as provided by rule 1301:9-2-17 of the Ohio Administrative Code.  Please print or type all answers.

To assist in the application process, a credit union may verify the proposed select group
is already in another credit union's field of membership by calling the Division's Corporate
Section at (614) 728-8400.

Section 1

Name of applicant Credit Union:  Telhio Credit Union
Address:  96 North Fourth Street, Columbus, OH   43215-9720
Contact Person:  BJ Stone, Business Development Manager
Phone Number:  (614) 221-3233 x 8194

Section 2
Complete legal name of the select group (For example, a corporation
should use the legal name of the corporation as set forth in its Articles of Incorporation)

________________________________________________________________________
DBA (doing business as) if applicable

_________________________________________________________________________
Street Address:

_________________________________________________________________________
City:                                                      State:                       Zip:
 
_________________________________________________________________________

I, ____________________________________________________________________, as
authorized representative of the above-name select group, hereby request service from the
applicant credit union on behalf of the select group, and certify that the above-named select
group (check one) ____ is or ____ is not currently being served or is eligible to be served by
another credit union.

__________________________________________________________________________
Signature of Authorized Representative                                    Date                 Phone Number

Section 3
The common bond for the select group must be either occupation or association.  A common bond
of occupation exists when the member of the group are employed by a single employer.  A
common bond of association exists when the members of the group belong to a sign organization,
club or association. 
The proposed select group's common bond is (check one)
____ occupational or ____ associational

Section 4
What is the approximate number of persons in the proposed select group?
________

Section 5
How many people in the proposed select group are likely to become
members of the credit union? ________

Section 6
What is the distance between the select group's work/meeting place and
the nearest credit union office? ________ mile(s)
The nearest office is the ____ home office or ____ a service facility/branch

Please give the address on the nearest credit union office to the group
IF IT IS NOT THE HOME OFFICE:
____ East Office:  201 Outerbelt Street, Columbus, OH  43213
____ North Office: 54 West Wilson Bridge Road, Worthington, OH 43085
____ West Office: 3580 Fishinger Blvd, Hilliard, OH 43026
____ Northland Office: 1681 Morse Road, Columbus, OH 43229
____ Website: www.telhio.org

Section 7
Will the credit union be offering payroll deduction services to this group? 
____ yes  or  ____ no

Section 8
Does the addition of this select group involve expansion of the credit
union's services beyond the boundaries of the State of Ohio? 
_____ yes  or ____ no
If yes, please list which state(s) would be affected:

__________________________________________

Please allow 4-6 weeks for approval of your application.
PLEASE PRINT THIS APPLICATION, SIGN AT THE APPROPRIATE PLACE AND MAIL TO:
Telhio Credit Union, Business Development
96 North Forth Street, Columbus, OH   43215