Marine Bank & Trust - ATM and Branch Locator

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Marine Bank & Trust Checking, Savings or CD Application

flag As required by the
USA PATRIOT ACT
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.

Marine Bank & Trust thanks you for your understanding for joining us in securing a safer tomorrow.

To apply for your account(s), please completely fill out the application, print it and mail it with your opening deposit and photocopies of your valid driver's license to:

Attn: New Accounts
Marine Bank & Trust
PO Box 190
Carthage, IL 62321

Upon approval of your application and receipt of your opening deposit, Marine Bank & Trust will open the account(s) requested and send you a receipt and other important information about your account(s).Accounts opened will be subject to Marine Bank &T rust's rates, fees and balance waiver requirements. Your opening deposit should be a check made payable to Marine Bank & Trust. Note: If you are not an area resident, you must send it by wire or electronic transfer. If you have any questions regarding this application, please call us at 1-217-357-3151 and ask for New Accounts, or email us. **

**Please note that any e-mail directed from your location is not secure nor encrypted.
Marine Bank & Trust encourages you NOT to include any sensitive financial information. This information may include: Account Numbers, Account Balances, PIN's Passwords, Social Security Numbers, Tax ID Numbers, and/or any other information which you may deem as sensitive.

NOTE: You do not need to fill out the pink shaded areas unless you have a co-applicant. If you would like to name a beneficiary or have any other special account title requests, please attach a separate sheet with your instructions and enclose any supporting documents necessary.

I. ACCOUNT SELECTION(S)

Checking Account:

Type of Account to Open

Initial Deposit

Choose one of the following for your account:
MasterMoney Card
(An ATM card that works like a check anywhere Debit MasterCard is accepted)
ATM Card
(Get cash at any ATM machine where you see the Cirrus or Shazam logos!)

Bank Use Only

Savings Account:

Type of Account to Open

Initial Deposit:

Bank Use Only

Money Market Account:

Type of Account to Open

Initial Deposit:
(minimum to open Money Market is $1000;
minimum to open Money Market Plus is $2500)

Bank Use Only

CD Time Deposit Account:

Type of Account to Open

Initial Deposit:

(min opening deposit of $1,000)

Bank Use Only

How do you want your interest paid?

Keep my money working - add to my principal

Deposit interest to my MarineBank & Trust checking/savings account no.

Send me a check

TOTAL
NOTE: Non-local deposits totaling over $25,000 must be sent by cashier's check, wire or electronic transfer.

(write your check for this amount)

Bank Use Only

II. ACCOUNT HOLDER(S) INFORMATION

Primary Applicant's Information:
(include suffix (Jr., Sr.) if applicable)

Prefix

Mr Mrs Ms

First Name

Last Name

Suffix

Business Name
(if applicable)

Phone

Date of Birth

Social Security Number/Tax ID Number

Drivers License Number

Address

City
State
ZIP
E-mail:

Mother's maiden name or password

Joint Applicant's Information:
(include suffix (Jr., Sr.) if applicable)

Prefix

Mr Mrs Ms

First Name

Last Name

Suffix

Phone

Date of Birth

Social Security Number

Drivers License Number

Address

City
State
ZIP
E-mail:

Mother's maiden name or password

III. EMPLOYMENT INFORMATION

Primary Applicant's Employment:

Check if self-employed

Name of Employer

Address

City
State
ZIP
Phone

Joint Applicant's Employment:

Check if self-employed

Name of Employer

Address

City
State
ZIP
Phone

IV. PERSONALIZED CHECK ORDER INFORMATION

I (we) would like to receive checks for this account (complete the area below)

I (we) do not wish to receive checks for this account (move to Section V.)

Please list your personal information as you would like it to appear on your printed checks. Any optional fields left blank will not appear on your checks. You will receive your checks in the mail 2-3 weeks after we receive your deposit.

Applicant's Name	OPTIONAL FIELDS
Joint Applicant's Name	Phone Number
Street Address		Applicant's ID (Driver's License, SSN, etc.)
City State ZIP		Joint Applicant's ID (Driver's License, SSN, etc.)

Additional Instructions:

V. CERTIFICATION
For Social Security Number verification purposes, please read and sign the following.

Under penalties of perjury, the undersigned certifies that: 1) the number on this form is my correct taxpayer identification number: (TIN) and 2) I am not subject to backup withholding because one of the following applies: I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends or the IRS has notified me that I am no longer subject to backup withholding. You must cross out item( 2) above if you have been notified by the IRS that you are currently subject to backup withholding.

Check the box which applies:

Foreign Recipient: I certify that I am neither a resident nor a U.S. citizen and therefore, I am not subject to backup withholding. Also, I've provided my permanent address to the bank.

Applied for TIN: I certify that a TIN has not been issued to me and that I have applied or intend to apply for a TIN. I understand that this account is subject to immediate withholding of 31% of any payments made to me until I provide a certified TIN to the bank. I further understand that if no TIN is provided within 60 days, the Bank has a right to close this account and deliver the proceeds to me, less any penalties and less any amounts withheld pursuant to this provision.

The certifications above do not apply to all signers. Individual certifications have been provided by all account owners.

The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to avoid backup withholding.

Applicant
Signature

Applicant TIN
(Social Security Number/
Tax ID Number)

Joint Applicant
Signature

Joint Applicant TIN
(Social Security Number)

VI. AUTHORIZATION TO OPEN ACCOUNT(S)

ACCOUNT AGREEMENT: Everything that is stated in this new account application is correct to the best of my (our) knowledge. I (We) give this information for the purpose of obtaining the type of account(s) stated on this application. I (We) authorize the Bank to obtain information concerning any statements made here; to answer any questions about its credit experience with me (us); and to share any information obtained concerning or contained in this application with third parties; including credit reporting agencies. I (We) understand that a credit report may be requested in connection with this application.

I (We) authorize the sharing of this application, any information relating to the account(s) opened and any information obtained concerning this application with any of the Bank's affiliates.

JOINT WITH RIGHT OF SURVIVORSHIP AGREEMENT (if more than one signature): We intend to and do hereby create a joint account with rights of survivorship.

I (We) understand and agree that when the Bank opens the account(s) requested, I (We) will be bound by the terms and conditions governing the accounts as they may be amended from time to time.

Applicant

Date

Joint Applicant

Date

Bank Use Only (Name)

Bank Use Only (Acct #)

Double check to make sure the application is completely filled out, print it and sign it, and mail it with your opening deposit and photocopy(s) of your valid driver's license to:

Attn: New Accounts

Marine Bank & Trust

PO Box 190

Carthage, IL 62321

Please Note: If you are not an area resident, and your total deposit amount exceeds $25,000, you must send it by wire or electronic transfer.