Online Certificate of Deposit Application Start earning Higher Interest right now! Please fill out the form below to submit your M&F Bank Online CD Application. Although, you will be required to visit your nearest location to finalize your new CD account, this application offers you the convenience of filling out standard account information 24/7 that will save you valuable time prior to stopping by. *Required field. For any questions, please call 1.800.379.5465. *I have read and I understand all the disclosures on the previous pages. Where would you like to bank. Choose one from these choices: Branch Locations: Choose One* Choose Branch Location Here * Select your Certificate of Deposit Term: (Contact your local branch for current rates) 6 Month 9 Month 13 Month 36 Month * Opening Deposit (Min. $1,000): $___________ Check Cash Other Interest will be compounded quarterly and credit quarterly unless otherwise requested in the special instructions section. Special Instructions: Individual Account Joint Account (the fields that are required for the primary account owner (*) will also be required for the Co-Owner) *Selection of Individual Account or Joint Account is required Primary Account Owner (The name in which interest will be reported for income tax purposes.) Your Full Name*:_________________________________ Email Address:__________________________________ Date of Birth:*____________________________________ Mother’s Maiden Name:____________________________ Employer:_______________________________________ Employer Phone Number:___________________________ ID Number:* (SSN or Tax ID)_________________________ Telephone (home phone w/area code):*_ ___ Telephone (Cell phone w/area code)____________________ Street Address:*____________________________________ City:*____________________ State:*____________ Zip Code:*_____________ Name and address of someone who will always know your location: ___________________________________________________________________ *Mailing address selection required Mailing Address is the same as above Mailing Address is different, enter below Mailing Address:________________________________________ City:__________________________________________________ State: ________ Zip Code: ____________ Driver’s License Number:*________________________ Date of Issue*__________________________________ Date of Expiration:*______________________________ State of Issue:*__________________________________ Co-Owner Full Name: Full Name (first, middle, last): Identification Number: _____________________________________ Date of Birth: ____________________________________________ Mailing Address: _________________________________________ City: ___________________________________________________ State: Zip Code: __________________________________________ Telephone (homephone w/area code): ________________________ Co-Owner Street Address: __________________________________ Co-Owner City: ___________________________________________ Co-Owner State: __________________________________________ Co-Owner Zip Code: _______________________________________ Co-Owner Driver's License Number: ___________________________ Co-Owner Date of Issue: ____________________________________ Co-Owner Date of Expiration: ________________________________ Co-Owner State of Issue: ____________________________________ Taxpayer Identification Number Certification/Backup Withholding: Please check the first box below indicating it is a true statement, and any of the remaining boxes that apply to you. TIN: __________________________ I, the primary account holder, as required by federal law, certify under penalties of perjury that the number shown above as my Taxpayer Identification Number(s) (TIN) or, the Social Security Number(s) (SSN) shown above is correct, and that I am a U.S. person (including a U.S. residernt alien). (required selection below) BACKUP WITHHOLDING - I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding. EXEMPT RECEPIENTS - I am an exempt recipient under the Internal Revenue Service Regulations. Submitting Your Application By submitting your CD application online, our representatives will already have needed information to help speed up the account opening process. This means more convenience and less wait time when you visit the location to finalize your new account. Once your application has been submitted, you will be contacted by the nearest M&F Bank representative. At which time, you will be asked a time that is convenient for you to finalize your new Certificate of Deposit. In order to complete the account, you will need to visit the M&F branch, present two forms of I.D., sign a signature card and fund the account. If you prefer, you may print the application and deliver it to your nearest M&F location for account opening. Thank you for choosing M&F Bank. Clicking “Submit” more than once will result in duplicate applications being submitted. Submit Print “Submit" — "This option allows you to send this application to the bank via the web using a secure server." "Print" — "This option allows you to print out the application so that you can bring or mail the application to the bank."
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