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

Account Type

Primary Account Holder Information

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mother's Maiden Name Driver's License Number State Issued Date of Expiration Issue Date Street Address City State Zip Code Mailing address is different than street address. Mailing Address City State Zip Code Home Phone Number Work Phone Number Cell Phone Number E-mail Address Please do NOT email me important news and updates. Occupation Employer Name

Joint Account Holder Information

Are you applying for an individual or joint account?

Individual
Joint

Ownership

Ownership type

Single Owner (individual)
Joint (with right to survivorship)
Joint (with no right to survivorship)
Payable on Death

Beneficiary Information.

First Name Middle Initial Last Name Suffix Social Security Number Street Address City State Zip Code Relationship to holder

Opening Deposit

Deposit Amount Deposit Type

Account Preferences

Debit Card
Direct Deposit
Online Banking
Bill Pay w/ Popmoney
Mobile Banking
Bill Payment
eStatements

Endorsement

As a condition of acceptance of my deposit application, I authorize you to obtain a copy of my current credit report and subsequent reports for the purpose of an update, renewal or extension of credit. I am not subject to backup withholding, because I am exempt from backup withholding, or because I have not been notified by the IRS that I am subject to backup withholding as a result of failure to report all interest or dividends, or because the IRS has notified me that I am no longer subject to backup withholding. I am subject to backup withholding. I am not a United States citizen or resident. I certify under penalties of perjury that the statements contained in this section are correct.

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 (Kentucky Residents) (Tennessee Residents), Disclosures and Privacy Policy. I agree that I may receive electronic communications posted on the United Cumberland Bank web site or delivered to the e-mail address I provide, including information required by various laws and regulations. I authorize United Cumberland Bank to access my credit bureau information, check my employment, and report to credit reporting agencies United Cumberland Bank's experience with me.

Primary Account Holder's Signature Date Joint Account Holder's Signature Date Verify your not a robot