Checking and Savings 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.

General

Ownership

Ownership type

If payable on death, enter beneficiary information.

Primary Account Holder

Opening Deposit

Services Needed

Check all that apply

The purpose of this questionnaire is to being the application process. All applications are subject to approval. We will contact you once the application has been reviewed.

Endorsement

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, Disclosures, and Privacy Policy. I agree that I may receive electronic communications posted on the Fiserv web site or delivered to the e-mail address I provide, including information required by various laws and regulations.