Platinum Checking Application

Personal Information

  • Are you a new customer?

    OK Are you a new customer? is required
  • OK Name is required

  • Social Security Number

    - -
    OK Social Security Number is required
  • OK Drivers License Number is required
  • OK State Licensed Issued is required

  • Date of Birth

    OK Date of Birth is required

  • Home Phone

    - -
    OK Home Phone is required

  • Work Phone

    - -
    OK Work Phone is required

  • Daytime Phone

    - -
    Optional OK Daytime Phone is required
  • OK Mother's Maiden Name is required
  • OK Email is required

Address Information

  • OK Residential Address (Not a P.O. Box) is required
  • OK City is required
  • OK State is required
  • OK Zip is required

  • Use residential address for mailing address

    OK Use residential address for mailing address is required
  • OK Mailing Address (if different than above) is required
  • OK City is required
  • OK State is required
  • OK Zip is required

Joint Account Information

  • Number of Joint Owners on this Account

    OK Number of Joint Owners on this Account is required

Joint Applicant #1

  • OK Relationship to Primary Applicant is required
  • OK Name is required

  • Date of Birth

    OK Date of Birth is required

  • Social Security Number

    - -
    OK Social Security Number is required
  • OK Drivers License Number is required
  • OK State Licensed Issued is required

  • Home Phone

    - -
    OK Home Phone is required

  • Work Phone

    - -
    OK Work Phone is required
  • OK Residential Address is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • OK Email is required

Joint Applicant #2

  • OK Relationship to Primary Applicant is required
  • OK Name is required

  • Date of Birth

    OK Date of Birth is required

  • Social Security Number

    - -
    OK Social Security Number is required
  • OK Drivers License Number is required
  • OK State License Issued is required

  • Home Phone

    - -
    OK Home Phone is required

  • Work Phone

    - -
    OK Work Phone is required
  • OK Residential Address is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • OK Email is required

Comments

  • Optional OK is required

Security Code

  • OK is required

    • First Citizens Community Bank reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, you grant full permission to do so.

    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 that 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.

    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 that 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.

    On September 11, 2001, our lives changed forever. In an effort to protect you and our country, the USA PATRIOT Act was signed into law. 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.

    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 ask to see your driver's license or other identifying documents.

    Effective May 11, 2018, new rules under the Bank Secrecy Act will aid the government in the fight against crimes to evade financial measures designed to combat terrorism and other national security threats.

    Each time an account is opened for a covered Legal Entity, we are required to ask you for identifying information (name, address, date of birth, social security number as well as identification documents) for:

    Each individual that has beneficial ownership (25% or more); and, One individual that has significant managerial control, of the Legal Entity. If you are opening an account on behalf of a Legal Entity, you will be required to provide the appropriate documentation and to certify that this information is true and accurate to the best of your knowledge.