Primary Account Owner

indicates a required field

Name (First M. Last) Date of Birth (mm/dd/yyyy) Social Security Number Address City State Zip Home Phone Number Work Phone Number Driver's License Number State E-mail

Business Information

Business Type

Sole Proprietorship
Corporation - For Profit
Corporation - Non Profit
Partnership
Limited Liability Company

Business Name Address Owner(s) Federal Tax ID

Deposit Information

Initial Deposit Initial Deposit Type

Taxpayer Identification Number Certification

The Social Security Number(s) shown above is my correct SSN. I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding. I am an exempt recipient under the Internal Revenue Service Regulations. I am not a United States person, or if I am an individual, I am neither a citizen nor a resident of the United States. I certify under penalties of perjury the statements checked in this section are true. I authorize C&F Bank to obtain a copy of my current credit report as a condition of acceptance of this application and for the purpose of extension of or renewal of credit. I would like to access this account through Online Banking.