The Internal Revenue Service does not require your consent to any provision of this document other than certification required to avoid backup withholding. See Taxpayer Identification Number Certification below.
Taxpayer Identification Number Certification: Under the penalties of perjury, I certify that (1) the number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and (2) I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding, or (c) the IRS has notified me that I am no longer subject to backup withholding as a result of failure to report all interest or dividends, or (d) the IRS has notified me that I am no longer subject to backup withholding, and (3) I am a U.S. person (including U.S. resident alien).
Certification Instructions: You must cross out item (2) above if you have been notified by the IRS that you are currently subject to backup withholding because of under-reporting interest or dividends on your tax return unless you have received another notification form from the IRS that you are no longer subject to backup withholding.
I understand that if I do not provide a taxpayer identification number to Citizens Trust Bank within sixty (60) days, then Citizens Trust Bank is required to withhold twenty percent (20%) of all reportable payments thereafter made to me until I provide a number.
By submitting this application, I (each person jointly and severally) apply for the Certificate of Deposit listed above. As a Certificate of Deposit owner, I am subject to all of its bylaws and rules as amended from time to time. I certify that all information provided is true and correct.
I agree at any time you may request credit record information from credit reporting agencies about my credit or accounts and to receive and provide credit or account information about you. You also authorize any person that we contact to furnish us with any information that we request. You agree that such information will remain our property whether or not an account is opened for you. You authorize us to contact you in the future by telephone about additional products and services offered by or through us or our affiliates, and you consent to our use of information about you for marketing purposes related to such additional products and services. I Understand/Agree