Deposit Product Application Form

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Deposit Product Application Form

Deposit Product Application

Ready to apply for a Certificate of Deposit? Simply fill out the form below to start the application process.

* Required Information

Product Information

Select CD Type

* The 1- Year Birthday CD is only offered to our Centier Advantage clients.

Account Type

Initial Deposit ($1000 Minimum Required)

Deposit Type

Preferred Location to Finalize Paperwork

Applicant Information

Name (First M. Last)

Mailing Address

Address Line 2

City

State

Zip

Daytime Telephone Number

Daytime Telephone Extension

Second Telephone Number

Social Security Number

Mother's Maiden Name

Date of Birth

Occupation

Employer

Employer Phone Number

Driver's License or State ID Number

Driver's License State

Driver's License Issue Date

Driver's License Expiration Date

Email Address

Joint Account Holder Information

Joint Account Holder - Name (First M. Last)

Joint Account Holder - Mailing Address

Joint Account Holder - Address Line 2

Joint Account Holder - City

Joint Account Holder - State

Joint Account Holder - Zip

Joint Account Holder - Daytime Telephone Number

Joint Account Holder - Daytime Telephone Extension

Joint Account Holder - Second Telephone Number

Joint Account Holder - Social Security Number

Joint Account Holder - Mother's Maiden Name

Joint Account Holder - Date of Birth

Joint Account Holder - Occupation

Joint Account Holder - Employer

Joint Account Holder - Employer Phone Number

Joint Account Holder - Driver's License or State ID Number

Joint Account Holder - Driver's License State

Joint Account Holder - Driver's License Issue Date

Joint Account Holder - Driver's License Expiration Date

Joint Account Holder - Email Address

Additional Products

Products of Interest
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.

Products of Interest

Additional Information

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.

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