Online Certificate of Deposit Application by few71840


									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 Phone Number:___________________________
ID Number:* (SSN or Tax ID)_________________________
Telephone (home phone w/area code):*_ ___
Telephone (Cell phone w/area code)____________________
Street Address:*____________________________________
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:________________________________________
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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