Bank of Utica | Checking Account Application

Checking Account Application

(local deposits only)

New Account Information

* Indicates a required field

*Checking Account Type

*Initial Deposit Amount

Subject to Initial Deposit Requirements

Account Ownership

Individual Joint

Source of Deposit

Other Bank Mail Check Bank of Utica Account

*Other Bank's 9 Digit Routing Number

This number can be found on your personal checks, or by calling the bank to which the funds will be transfered from. When looking at a check, the 9 digit number is typically the left most series of numbers surrounded by a special symbol on either side.

Other Bank's Name (Optional)

*Account Number at Other Bank

*Type of Account at Other Bank

*Effective Date / /

Note: Only Required if Source of Deposit is an Account Transfer from another Bank

Your Name & Address Information

Name * *

Note: Your Middle Initial is Optional - First and Last Names are required

*Mailing Address

*City

*State

*Postal Code -

Legal Address - Physical Address

Legal Address - City/State/Postal Code

Hint: Please use the Legal Address fields in cases where your mailing address is a P.O. Box. Enter your City, State and Postal Code e.g. Utica, NY 13502

Contact Information

*Email

*Home Phone - -

Work Phone - - Ext:

Cell Phone - -

Identification Information

*Personal Account Access Password

Please select a password that will be unique to you personally. This password will be used to assist us in verifing your identity should you call the Bank for account information. Do not select something that is obvious to others, but at the same time, choose a password that you will remember.

*Social Security Number - -

*Mother's Maiden Name

A First Name is not required, please enter Last Name only when submitting your Mother's Maiden Name.

*Date of Birth / /

ID Type

*Identification Number

*Identification Issued By

ID Issue Date / /

ID Expiration Date / /

Designation of Beneficiaries

The following individual(s) or entity shall be my primary and/or contingent beneficiary(ies). If neither primary nor contingent is indicated, the individual or entity will be deemed to be a primary beneficiary. If more than one primary beneficiary is designated and no distribution percentages are indicated, the beneficiaries will be deemed to own equal share percentages in the account. Multiple contingent beneficiaries with no share percentage indicated will also be deemed to share equally. If a primary or contingent beneficiary dies before me, his or her interest and the interest of his or her heirs shall terminate completely, and the percentage share of any remaining beneficiary(ies) shall be increased on a pro-rated basis. If no primary beneficiary(ies) survives me, the contingent beneficiary(ies) shall acquire the designated share of my account.

Designate Beneficiaries

Yes No

Beneficiary 3

Name * *

Note: Your Middle Initial is Optional - First and Last Names are required

*Legal Address

*City

*State

*Zip

Social Security Number - -

Date of Birth / /

Home Phone - -

Enhanced Banking Features (Free)

If you would like Enhanced Banking Features please provide a 4 digit PIN at this time:

What features would you like to use?

Online Banking

Bill Payment (Excluding Certificates)

Telephone Banking

*I certify that the above information is correct and that I have read and agree to abide by the terms, conditions, and account requirements. I understand that Bank of Utica may request information from a consumer reporting agency to determine my eligibility for this account. Under the Fair Credit Reporting Act, if the bank does not approve my application to open an account, I will be notified in writing and I will have the right to obtain a free copy of this report.

* I/We agree to receive the Bank's disclosures electronically and acknowledge that I/We have read the Bank�s disclosures made available to me at this location. I/We agree to the terms and conditions as therein set forth in each, now and as amended and/or supplemented by Bank from time to time.

If you have any questions please feel free to enter them below, or contact our Personal Banking Department at (315) 797-2700 ext. 264.

Comments / Questions

Enter a description of your question/issue.

Bank of Utica - Central New York - Mohawk Valley - Member FDIC

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Checking Account Application