Centier

Deposit Product Application

Ready to apply for a Checking account, Savings account, or a Certificate of Deposit? Simply fill out the form below to start the application process.

Deposit Product Application Form

Product Application

Required information*

To apply for an account please check the box(s) below.

Checking Account

Savings Account

Certificate of Deposit

Please select your preferred location to finalize paperwork*

Date :
Name*
Mailing Address*
Address Line 2
City*
State*
Zip*
Daytime Telephone Number
(XXX) XXX-XXXX*
ext.
Second Telephone Number
(XXX) XXX-XXXX
Your Social Security Number*
XXX-XX-XXXX
Mother's Maiden Name
Date of Birth*
MM/DD/YYY
Occupation
Employer
Employer Phone Number
Driver's License or State ID Number*
State*
Drivers License Issue Date*
MM/DD/YYYY
Drivers License Expiration Date)*
MM/DD/YYYY
E-mail Address*

Joint Account Holder Information

Name*
Mailing Address*
Address Line 2
City*
State*
Zip*
Daytime Telephone Number*
(XXX) XXX-XXXX
ext.
Second Telephone Number
(XXX) XXX-XXXX
Your Social Security Number*
XXX-XX-XXXX
Mother's Maiden Name
Date of Birth*
MM/DD/YYYY
Occupation
Employer
Employer Phone Number
Driver's License or State ID Number*
State
Drivers License Issue Date*
MM/DD/YYYY
Drivers License Expiration Date*
MM/DD/YYYY
E-mail Address*

If you are interested in any of the following additional products, please check the box(s) below. A member of our Client Service Center will contact you to go over your options, and application details.

Online Banking
Online Bill Pay
Electronic Statements
Visa Debit Card
Direct Deposit
Credit Card
Mobile Banking
Round Up Savings

Certification: I certify under penalties of perjury that the statements contained in this section are correct:

Taxpayer ID Number

(Leave blank if same as your Social Security Number)

Taxpayer ID Number Certification
	The Taxpayer Identification Number shown above is my correct taxpayer identification number.
Backup Withholding
	I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding.
Exempt Recipients
	I am an exempt recipient under the Internal Revenue Service Regulations.
Nonresident Aliens
	I am neither a citizen nor a resident of the United States.

Government regulations require that financial institutions make disclosures available to you when you open a new account. The following link directs you to the disclosures you will see when you open an account in one of our branches.
Click here to View Disclosures

Please read before submitting online: When you have completed this form, press the submit button to send your application electronically to our secure mail. We will validate your requested information and contact you within two business days to discuss the location where you would like to finalize your paperwork and open your account.

Online Banking: You may access your Checking, Savings, CD, Loan and IRA accounts at no cost through the Internet, seeking updated account information and transferring funds between accounts after your Online Banking application has been processed. A checking account is required for online access. Images of written checks are available online.

Online Banking with Bill Pay
For Clients not receiving email statements there will be a service charge of $5.95 per month posted to the checking account you designate for bill payment.

Online Banking with Bill Pay and E-Statements:
For Clients receiving email statements, Bill Pay is free.

If you would like to add this account to your existing Online Banking access, please contact your local branch, or the Client Service Center with the request.

Need assistance? Contact our Client Service Center at 756-BANK (756-2265) or 1-888-CENTIER (1-888-236-8437) from 7:00 AM to 7:00 PM weekdays and 8:00 AM to 2:00 PM on Saturdays. Or e-mail us at support@centier.com. We'll be happy to assist you.