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UBM Direct Savings Account Application

 

* Required fields
 

What type of application is this?
 
 
Do you wish to list beneficiaries?
 
 

Beneficiary Information


Beneficiary 1

Beneficiary 2

Personal Information


(If no middle name, enter "None")

Primary Applicant's Identification (Driver's License or State Identification Information)

Physical Address

Length of time at Primary Applicant's current address 
 

Mailing Address - if Different than above

Joint Applicant Information


(If no middle name, enter "None")

Joint Applicant's Identification (Driver's License or State Identification Information)

Joint Applicant's Physical Address

Length of time at Joint Applicant's current address 
 

Checking Account Information


To Transfer funds to and from your UBM Direct Savings Account

 

Initial Deposit Information


How will you fund this account?

Source of Deposit 
 
     
    The deposit amounts must match
    Would you like to enroll in the Automatic Savings Plan?       

    Please note that the amount will be taken from your checking account referenced previously in this application at the amount and frequency you provided until we receive notice from you to stop the savings plan.

    IRS W-9 Certification

    I understand my account will be governed by the account terms and conditions in the account disclosure. By submitting this application, I agree to be bound by those terms and conditions. I also understand that I can close my account at any time and will receive all of my money in full, along with any interest owed to me, after any incurred fees or service charges. Under penalty of perjury, I certify that my Social Security Number on this application is my correct number. I am a U.S. person (including U.S. resident alien), and that (check the appropriate box):

    Which of the following statements about IRS W9 Certification do you agree with?
     
     

    By clicking submit, I certify that the above information is correct and that I have read and agree to abide by the account requirements.

    There was an error submitting the form
    Thank you - your application has been submitted.  If you have questions, please contact us at 800-421-2588 and select option 2 or email tech@ultimabank.com