New Deposit Account Application

Important Information About Procedures For Opening A New Account:

PATRIOT ACT
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.

Required Field

General

Please choose the type of account you are applying for:

Account Type

Are you applying with a joint applicant?

Applicant Options

Primary Account Holder Information

First Name Middle Initial Last Name Social Security Number Drivers License Number Drivers License State Issued Drivers License Date of Issuance Drivers License Date of Expiration Home Phone Work Phone Ext: Date of Birth Mother's Maiden Name Occupation Employer

Joint Account Holder Information

First Name Middle Initial Last Name Social Security Number Drivers License Number State Issued Date of Issuance Date of Expiration Home Phone Work Phone Ext: Date of Birth Mother's Maiden Name Occupation Employer

Address Information

Street Address City State Zip Code E-mail Address

Mailing address (if different from above)

Street Address City State Zip Code

Account Ownership

Ownership Options

Single Owner (individual)
Joint (with right to survivorship)
Joint (with no right to survivorship)

Beneficiaries

If Payable on Death, Name and Address of Beneficiary

Beneficiary Information

First Name Middle Initial Last Name Street Address City State Zip Code Relationship

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Account Preferences

Preference Options

MasterCard Debit Card/ATM Card
E-Statements
Direct Deposit
Full Time Student
I would like more information regarding Overdraft Protection
Before account opening, the bank will contact you regarding the bank’s standard overdraft practices.

Taxpayer Identification

As a condition of acceptance of my deposit application, I authorize you to obtain a copy of my current credit repot and subsequent reports for the purpose of an update, renewal or extension of credit. I am a US Citizen. I am NOT a US Citizen. I certify under penalties of perjury that the statements contained in this section are correct.

Endorsement

By submitting this application, I/we certify that I/we truthfully and fully provided the information required, that I am/we are at least 18 years of age. I/we agree that I/we may receive electronic communications through Coffee County Bank’s Website or delivered to the email address that I/we have provided, including information required by various laws and regulations. I/we authorize the Bank to access my/our credit bureau information, check my/our employment, and report my/our credit history with the Bank.

I will come in and sign my Signature Card and make my required deposit for the account selected.

Coffee County Bank will contact you upon receipt of documentation to provide you with the Terms & Conditions, Disclosures, Privacy Policy, signature card for the account selected, and to schedule a time that is convenient.