Investment Accounts Application

Important Information About Procedures For Opening A New Account & The 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

Privacy Policy:

Our privacy policy protects the privacy of your personally-identifying information that you provide us online.

Important Information about Procedures for Opening a New Account

Identification Procedures Requirements: 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 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.

Account Information

Primary Account Holder Information

Joint Account Holder Information

Are you applying for an individual or joint account?

Ownership

Ownership type

Beneficiary Information.

Opening Deposit

Endorsement

The Internal Revenue Service does not require your consent to any provision of this document other than certification required to avoid backup withholding. See Taxpayer Identification Number Certification below.

"Taxpayer Identification Number Certification: Under the penalties of perjury, I certify that (1) the number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and (2) I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding, or (c) the IRS has notified me that I am no longer subject to backup withholding as a result of failure to report all interest or dividends, or (d) the IRS has notified me that I am no longer subject to backup withholding, and (3) I am a U.S. person (including U.S. resident alien). Certification Instructions: You must cross out item (2) above if you have been notified by the IRS that you are currently subject to backup withholding because of under-reporting interest or dividends on your tax return unless you have received another notification form from the IRS that you are no longer subject to backup withholding. I understand that if I do not provide a taxpayer identification number to Citizens Trust Bank within sixty (60) days, then Citizens Trust Bank is required to withhold twenty percent (20%) of all reportable payments thereafter made to me until I provide a number. By submitting this application, I (each person jointly and severally) apply for the Certificate of Deposit listed above. As a Certificate of Deposit owner, I am subject to all of its bylaws and rules as amended from time to time. I certify that all information provided is true and correct. I agree at any time you may request credit record information from credit reporting agencies about my credit or accounts and to receive and provide credit or account information about you. You also authorize any person that we contact to furnish us with any information that we request. You agree that such information will remain our property whether or not an account is opened for you. You authorize us to contact you in the future by telephone about additional products and services offered by or through us or our affiliates, and you consent to our use of information about you for marketing purposes related to such additional products and services."

By submitting this application, I certify that I/we gave truthfully and fully provided the information required and that I am at least 18 years of age and live in the US. I certify that I have read and agreed to all the Terms & Conditions and Disclosures. I agree that I may receive electronic communications posted on the Citizens Trust Bank web site or delivered to the e-mail address I provide, including information required by various laws and regulations. I authorize Citizens Trust Bank to access my credit bureau information, check my employment, and report to credit reporting agencies Citizens Trust Bank's experience with me.


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