Checking Account Application Opt-In

Submit this application, and send a copy of your picture I.D.*

To help the government fight the funding of terrorism and money laundering activities, financial institutions are required by Federal law to obtain, verify, and record information that identifies each person who opens an account. Identity verification also helps protect you and Peoples Bank from identity fraud. What this means for you - You will be asked to provide your name, address, date of birth, and other information, that will allow us to identify you. We will also ask to see your driver's license or other identifying documents.

*Please note, if approved, you must also fund your account with a minimum deposit of $30.00 before your account is activated.

OWNER INFORMATION:

(each owner must complete an application)

First Name: MI: Last Name: Physical Address: City: State: Zip: Length of time at current address: Mailing Address (if different from above): City: State: Zip: Social Security # or ITIN (123456789): Confirm SSN or ITIN (123456789): Date of Birth: US Citizen: *If NO, you must come into our location to continue unless you have a Peoples Bank approved Employer Certification Form. Best Phone # to Reach Me: 2nd Best Phone # to Reach Me: Alternate Phone #: E-Mail Address: Confirm E-Mail Address: Drivers License Number (or other approved photo ID): Issuing State Expiration Date:

What will this account be used for?

Types of deposits/withdrawals typically made? Select all that apply.

Cash What will be your typical monthly deposit amount?: Check What will be your typical monthly deposit amount?: ACH/Electronic What will be your typical monthly deposit amount?: Wire What will be your typical monthly deposit amount?:

Do you anticipate sending or receiving wires?

Will the wires be Domestic, International or Both?

Domestic(inside US)
International
Both

To/From which foreign countries: Employer: Occupation: Mother's Maiden Name:

Name and phone number of nearest relative not living with you:

Name Phone Number

Please check the following if applicable:

I would like to enroll in online banking I would like to sign up for direct deposit

NOTE: A copy of your unexpired government issued picture ID must be sent to pcs@pbparis.com. If your current address does not appear on your ID, include a recent utility bill or a paycheck stub that shows your current address.

NOTE: The following are the only accepted forms of government issued IDs: Drivers License, Passport, State ID

JOINT ACCOUNT:

(if you do NOT want a Joint Account, please skip this section)

Check here if there is a joint applicant

Note: Joint Applicant must also complete this form and send a copy of their unexpired government issued picture ID to pcs@pbparis.com.

Joint Applicant's Name: Physical Address: City: State: Zip: Length of time at current address: Mailing Address (if different from above): City: State: Zip: Social Security Number (123456789): Confirm Social Security (123456789): Date of Birth: US Citizen: Best Phone # to Reach Me: 2nd Best Phone # to Reach Me: Alternate Phone #: E-Mail Address: Confirm E-Mail Address: Drivers License Number (or other approved photo ID): Issuing State Expiration Date: What will this account be used for?

Types of deposits/withdrawals typically made? Select all that apply.

Do you anticipate sending or receiving wires?

Will the wires be Domestic, International or Both?

Domestic(inside US)
International
Both

To/From which foreign countries: Employer: Occupation: Mother's Maiden Name:

Authorization

The undersigned agrees to the terms stated on every page of this form and acknowledges receipt of a completed copy. The undersigned authorizes Peoples Bank to check credit and/or employment history should it be deemed necessary. The undersigned also acknowledges the receipt of a copy and agrees to the terms of the following disclosures: Deposit Account; Funds Availability; Truth in Savings; Electronic Fund Transfer; Privacy; Substitute Checks

e-Signature: Date:

Joint Applicant e-Signature: Date: