Online Deposit Account Application

• Applicant

• Legal First Name*
• Middle Initial
• Last Name*
• Alias
• Gender*

  Male Female
• Clue (question)*
• Password*

• The Clue and Password will be used to verify your identity. Think of it as a question and answer. Example: Clue - What street did I grow up on? Password - Lincoln Avenue

• Primary Residential Address*
• Address Line 2
• Zip*
• City*
• State* --- Select --- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

• Please note, if your address does not match what is on the identification provided, you will need to provide verification of your address (utility bill, lease agreement, medical bill, etc.) upon signing documents.

• Email Address*
• Primary Phone*
• Primary Phone Type

  Home Cell Work
• Secondary Phone
• Secondary Phone Type

  Home Cell Work

• Personal Information - Primary Account Holder

• Current Place of Employment*

• Identity

• Date of Birth*
• Social Security #*
• Identification Type*

  Driver's License State Identification Military Passport
• ID#
• Expiration Date
• Issue Date
• Issued In (State)
• Please select additional products/services you are interested in:

  ATM/Debit Card Online/Mobile Banking Remote Deposit Bill Pay People Pay eStatements (required with eVantage)
• If interested in lending services, select below and a lender will contact you.

  Credit Card Installment (Personal/Vehicle) Loan Mortgage Loan Home Improvement (Home Equity Loan)

• How did you hear about us?* -- Select Referral Source -- Our Website Google/Bing Search Facebook Twitter Friend/Family Member Radio TV Other

• IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT:

  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.

  I understand the above information will be used by Clinton National Bank to obtain verification of identity and background before opening any accounts. Clinton National Bank may also access information about you from a consumer reporting agency, such as a credit report or ChexSystems, before opening any account. If any of this information comes back unsatisfactory, CNB may decline to open the account.

• By checking here, you agree that the information you provided is accurate, and you agree to the above terms and conditions. Please take a moment to verify that all information is correct.
• Applicant's Signature*

All information is confidential and is intended to better serve our customer's needs. Thank you!