TITLE 74: PUBLIC FINANCE
CHAPTER V: TREASURER
PART 750 HOME OWNERSHIP MADE EASY ACT
SECTION 750.APPENDIX C ACCOUNT ENROLLMENT FORM

 

Section 750.APPENDIX C   Account Enrollment Form

 

ACCOUNT ENROLLMENT FORM

 

 

Owner's Name (First, Initial, Last)

 

 

-

 

-

 

 

Owner's Social Security Number

 

Date of Birth

 

 

 

 

 

Street or P.O. Box Number

 

Phone

 

 

 

City

State

Zip

 

 

 

 

 

Joint Owner's Name (First, Initial, Last)

 

 

 

-

 

-

 

 

 

 

Joint Owner's Social Security Number

 

Date of Birth

 

 

 

 

Street or P.O. Box Number

 

Phone

 

 

 

City

State

Zip

 

 

 

 

 

 

 

Date of Enrollment:

 

 

Initial Account Balance:

 

 

Check One:

 

 

New H.O.M.E. Saver

 

 

Transferred account

 

 

 

 

 

 

 

Investment type:

 

 

 

Deposit method:

 

 

 

Program Depository Name:

 

 

 

 

I/We hereby authorize the Program Depository to disclose to the Treasurer's Office such information as is necessary for verification of Program participation.

 

 

Signature

 

 

 

Signature

 

 

 

 

(Source:  Amended at 22 Ill. Reg. 15631, effective August 24, 1998)