Leave me blank for Deposit Form. Deposit Form To begin, please fill out the fields in the form below. One of our representatives will contact you within one business day to complete the process. This form uses 256 bit SSL encryption, ensuring that no one else will see your personal information while it is in-transit. Please view our Privacy Policy for more information. Individual (please select one) Joint (please select one) Are you a new customer? Yes No *Per government regulations (COPA), we cannot open accounts online for children under 18. Please fill in parent information and we will contact you for your child’s information. Select the account(s) for which you are applying: * Checking Accounts WooHoo! Checking WooHoo! Simple Make My Life Easy Checking Easy Interest Checking Savings Accounts WooHoo! U Regular Savings Investment Savings Certificate of Deposit Ultimate Investment Savings Individual Retirement Account Health Savings Account Educational Savings Account Customer Services Online Banking Go! Mobile Mobile Deposit Capture Bill Payment Bank-to-Bank Transfers Check Card Personal Information Full Name Name (First, MI, Last)* SSN Social Security Number * Why do we ask? In order to properly verify your identity, federal law requires we ask for a government-issued identification number, such as your Social Security number. This information is used solely for identity verification. Your Social Security number will not be used for any other purpose. DOB Date of Birth MM/DD/YYYY * Home Phone Home Phone * Daytime Phone Daytime Phone Mother's Maiden Name Mother’s Maiden Name * ID Drivers License Number * State of Drivers License State of Drivers License * Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia 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 DL Expiration Driver’s License Expiration MM/YYYY * Email Address Email Address * Address Information Residential Address Residential Address (Not a P.O. Box) * Residential Address City City * Residential Address State State * Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia 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 Residential Address Zip Zip * Use residential address for mailing address Mailing Address Residential Address (Not a P.O. Box) Mailing City City Mailing State State Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia 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 Mailing Zip Zip Employment Information Current Employer Current Employer Time with Current Employer # of Years with Current Employer JOINT - Personal Information Joint Applicant Name (Last, First, MI) * Joint SSN Social Security Number * Why do we ask? In order to properly verify your identity, federal law requires we ask for a government-issued identification number, such as your Social Security number. This information is used solely for identity verification. Your Social Security number will not be used for any other purpose. Joint DOB Date of Birth MM/DD/YYYY * Joint Home Phone Home Phone * Joint Daytime Phone Daytime Phone Joint Mother's Maiden Name Mother’s Maiden Name * Joint ID Drivers License or State ID * Joint State of Drivers License State of Drivers License * Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia 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 Joint License Expiration Driver’s License Expiration MM/YYYY * Joint Email Email Address * Address Information Joint Address Residential Address (Not a P.O. Box) * Joint City City * Joint State State * Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia 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 Joint Zip Zip * Use residential address for mailing address Joint Residential Address Residential Address (Not a P.O. Box) Joint Residential City City Joint Residential State State Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia 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 Joint Residential Zip Zip Employment Information Joint Current Employer Current Employer Joint Years with Employer # of Years with Current Employer Check Card Would you like to apply for a free Check card on this account? Yes No How did you hear about us? Newspaper Radio Email Search Engine Billboard Website Referred by Referred by name Promo Code How did you hear about us promo code Other How did you hear about us other Comments Comments Disclosures MN Statute 48.512, subd. 2, requires the following information to be provided by an applicant if this is a transaction account.* Have you had a transaction account at this or another financial intermediary within 12 months before making this application?* Yes No Have you had a transaction account closed by a financial intermediary without your consent within 12 months before making this application?* Yes No Have you been convicted of a criminal offense because of the use of a check or other similar item within 24-months of making this application?* Yes No IMPORTANT Please read the following disclosures before accepting. I/We have read and agree to the terms and conditions shown above and agree to conform to the bylaws and any amendments of the bank. I certify that statements on this application are true and complete. By checking “I accept”, you acknowledge you have read and agree to the Account Agreement. I Accept (Primary) I Accept (Joint) Check if under 18. If so, parent or guardian required to sign as joint holder. Citizens Bank Minnesota 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, I/We grant full permission to do so. This document is being secured using SSL encryption provided by your browser. Your information will be encrypted when using this form while in transit between your browser and Citizens Bank Minnesota. 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