Checking/savings application

NFG #2 Checking/Savings Application

What card type would you like to apply for?

Type of checking account

Type of savings account

Type of account

Initial deposit amount $

Source of deposit

Transfer from current account
Transfer from another institution
Check/Money order

I am also interested in

ATM card
ATM check/debit card
Credit card
Direct deposit

Account type

Individual Joint

Primary Account Holder

Applicant's name (First, M, Last) *

Birthday*

Social Security Number*

Driver's License Number

Driver's License State

Present Address*

Home Phone*

Business Phone

Email Address*

Employment

Employed by*

Start Date*

Co-applicant

Applicant's name (First, M, Last) *

Birthday*

Social Security Number*

Driver's License Number

Driver's License State

Present Address*

Home Phone*

Business Phone

Email Address*

Employment

Employed by*

Start Date*

TIN Certification and backup withholding information

By completing and submitting this document, I certify, under penalties of perjury

that the Social Security Number (SSN)/Taxpayer Identification Number (TIN) shown is my/the correct number

that I am NOT, unless designated below, 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 dividends or interest, or because the IRS has notified me that I am no longer subject to backup withholding

that I am a U.S. person (including a U.S. resident alien)

Office hours

NFG #2 Checking/Savings Application

Primary Account Holder

Employment

Co-applicant

Employment

TIN Certification and backup withholding information