Investment Accounts Application
Privacy Policy:
Our privacy policy protects the privacy of your personally-identifying information that you provide us online.

Account Holders must reside in    

Important Information about Procedures for Opening a New Account
Identification Procedures Requirements: 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 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.

Instructions:
1. Complete Application and click "Submit Application" or fax it to 404-659-7750.
2. To safeguard your privacy, QUIT your browser and restart it again after using this form. This form is NOT saved in your computer's memory when you quit your browser.
3. We will contact you with the location of our closest office for you to sign a signature card. You may also be requested to provide photocopies of your Social Security card and Driver's License, or other documentation.

Primary Joint Account Holder Information
First Name
    
Middle Initial
 
Last Name
    
 
Date of Birth
    
Social Security No.
    
Your Email Address
    
 
Home Phone
    
Driver's License No.
    
Driver's License State
   
 
Street Address
    
City
    
State
   
Zip
    
Subject to backup withholding     Work Phone
    
 

Is there a Joint Account Holder?    

If Yes, Please provide the the requested Joint Account Holder information below:


Joint Account Holder (with right of survivorship)
First Name
 
Middle Initial
 
Last Name
 
 
Date of Birth
 
Social Security No.
 
Your Email Address
 
 
Home Phone
 
Driver's License No.
 
Driver's License State
 
Street Address
 
City
 
State
Zip
 
Subject to backup withholding Work Phone
 
 

Payable on Death Beneficiary (if you selected POD ownership)
Name (First M. Last)  
SSN
 
Phone
 
City, State, Zip-Plus4
 

Account Titling Information
Account Titling Individual
Account Titling Joint
In Trust For Name   SSN  
Custodial Name   SSN  

I/We would like to apply for the following Certificate of Deposit:
Term Amount
3 Month $ 
6 Month $ 
9 Month $ 
1 Year $ 
2 Year $ 
3 Year $ 
5 Year $ 

Term Amount
12 Month Fixed $ 
30 Month Variable $ 

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

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