Account Application and Signature Card
Rewards Checking Includes: a Visa® Debit Card, Internet Banking, and Online Statements.
Please fill out the form below, include a copy of each account
holder’s valid driver’s license, and…
Return it to your neighborhood Peoples
or Fax to: 715.842.9050
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or M
ail to:
Peoples State Bank
Attention: Customer Service Department
P.O.Box 1686
Wausau, WI 54402-1686
Daytime phone you can be
reached at:
____________________________
Rememb
er to inclu
de
a copy o
f your
driver’s li
cense.
(You will receive a confirmation call at the
number provided upon approval)
Account Application (ALL FIELDS MUST BE COMPLETED)
You must be 18 to open a Peoples Rewards Checking Account. Your checking account application will be processed and is subject to credit approval.
Individual Account
Joint Account
Name
Name
Address
Since
Address
Since
City
Zip
City
Zip
State
Mailing Address (if different)
Mailing Address (if different)
Home Phone
Home Phone
E-mail Address
E-mail Address
Social Security Number
Social Security Number
Date of Birth
Date of Birth
Mother’s Maiden Name
Mother’s Maiden Name
Employer
How Long
State
Employer
Work Phone
Work Phone
Position
Position
How Long
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.
Definition of Individual and Joint Ownership:
Single/Individual Account is owned by the named party and upon the party’s death, ownership passes to the deceased party’s
estate. Joint account (with right of survivorship) is jointly owned by the named parties. Upon the death of any of them, the ownership
passes to the survivors who will continue to jointly own the account as a joint account (with right of survivorship).
Taxpayer Identification Number Certification
I certify under penalties of perjury that the taxpayer identification number (TIN) provided above is correct, I am a US person
(including a US resident alien), and I am either exempt from backup withholding under Internal Revenue Service regulations,
or I am not subject to backup withholding.
The above statement is true with the exception of:
I am subject to backup withholding because of underreported interest and dividends.
I have applied or will soon apply for a TIN.
If one is not provided to this institution within 60 days from this certification, I will be subject to backup withholding.
I am a Foreign Recipient and have provided this institution with the appropriate Form W-8 certification.
Questions:
1. W
ill you be utilizing the Wire Transfer service we have available? Choose
YES / NOOne
If YES, Domestic or Foreign? Choose One
2. This account is for personal use only. Choose
YES / NOOne
Acknowledgement: By signing this document, you acknowledge that you have opened a Peoples Rewards Checking, Online
Banking, Debit Card and agree to receive your statements electronically. You agree to have all required account disclosures: Terms
and Conditions of Your Account Agreement, Account Disclosure, Privacy Policy, Electronic Funds Transfer Disclosure, and Funds
Availability Policy sent to you the next business day of account opening and you will be bound by them. By signing this document
you authorize People State Bank to check your credit, employment history, obtain a credit report or use other methods to verify your
eligibility for any accounts or services you have requested now or in the future.
Primary Account Holder Signature ID
Date
Secondary Account Holder Signature Date
Remember to send a
copy of your driver’s
license.
Member FDIC
P.O. Box 1686
Wausau, WI 54402-1686
Bank Use ONLY:
Date Received
Employees Name
CIF Copy
Account Number
Account Officer
Copy to e Banking