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Peoples Bank
Certificate of Deposit Request

Privacy Policy:
Our privacy policy protects the privacy of your personally-identifying information that you provide us online.

Account Holders must reside in Crawford, Franklin or surrounding Counties in Missouri.

Important Information about Procedures for Opening a New Account
Identification Procedures Requirements: 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.

Security Notice:
You should ONLY fill out this Request on-line if you are using a browser with the latest security enhancements. If you don't have the latest version, download a copy now.

Instructions:
1. Complete Request and click "Submit Request" or fax it to 573-885-3971.
2. To safeguard your privacy, QUIT your browser and restart it again after using this form. This form is NOT saved in your computer's memory when you quit your browser.
3. We will contact you with the location of our closest office for you to sign a signature card. You may also be requested to provide photocopies of your Social Security card and Driver's License, or other documentation.

Primary Joint Account Holder Information
First Name
Middle Initial
Last Name
Date of Birth
Social Security No.
Your E-mail Address
Home Phone
Driver's License No.
Driver's License State
Street Address
City
State
Zip
Work Phone
Joint Account Holder (with right of survivorship)
First Name
Middle Initial
Last Name
Date of Birth
Social Security No.
Your E-mail Address
Home Phone
Driver's License No.
Driver's License State
Street Address
City
State
Zip
Subject to backup withholding Y N Work Phone
Account Titling Information
Individual Joint

I/We would like to apply for the following Certificate of Deposit:

Term Amount
3 month $
6 month $
9 month $
1 year $
2 year $
3 year $
5 year $