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Certificate of Deposit Account 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

Account Information

Primary Account Holder Information

If mailing address is different than street address:

Joint Account Holder Information

Are you applying for an individual or joint account?

Joint Account Holder

If mailing address is different than street address:

Add Another Account Holder


Ownership type

If payable on death, enter beneficiary information.

Add Another Beneficiary

Opening Deposit

CDs - $500 minimum deposit required.

IRAs - no minimum deposit required.

Products and Services Needed

A Mediapolis Savings Bank representative will be contacting you about our selections above to complete the account opening process.

How would you initially prefer to be contacted?

The purpose of this questionnaire is to begin the application process. All applications are subject to approval.


By submitting this application, I certify that I/we provided the information required and that I am at least 18 years of age and live in the US. I agree that I may receive electronic communications delivered to the e-mail address I provided.