Personal Savings Application

Type of Account*

Individual

Joint

Primary Account Owner

Name*

First Last

Physical Address*

Street Address Address Line 2 City State ZIP Code

Would you like to add a different mailing address?

Yes

Mailing Address

Street Address Address Line 2 City State ZIP Code

Phone*

Date of Birth

Social Security Number*

Joint Account Owner (if desired)

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth

Social Security Number*

What is the amount that you have to invest today?

How long would you like to invest for?

How often do you anticipate making withdrawals from your savings account?

How do you prefer to access funds?

ATM Card

Transfer to your Heritage Bank Checking Account

In Person Withdrawal

Check to Third Party

Which of the following benefits are important to you?

No minimum balance requirements

No monthly service charge

Highest possible interest rate

Saving for retirement with tax-free earnings

Savings for a specific goal

Saving for retirement with a tax deduction today

Saving for my child's education

None

Disclosures & Acknowledgements

USA Patriot Act Disclosure

On September 11, 2001 our lives changed forever. In an effort to protect you and our country, the USA Patriot Act was signed into law. To help the government fight the funding or 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.

You are applying for a deposit account. We therefore asked you for your name, address, date of birth and other information that will allow us to identify you. If you are not currently a Heritage Bank customer, we must also ask you to complete the driver’s license or other identifying information below.

Primary Owner's Driver’s License #*

Issuing State*

Issue Date*

Expiration Date*

Joint Owner's Driver’s License #*

Issuing State*

Issue Date*

Expiration Date*

Certification & Authorization

I/we understand that a bank employee will contact me to discuss product options and set up a time when I/we can come to the bank to finish opening the account (sign the account agreement and receive all of the necessary disclosures related to the product we choose). I/we understand that I/we will be the only individual(s) authorized to use this account. I/we authorize the bank to make inquiries to the credit bureau, and verify all information on this application. I/we acknowledge that all Heritage Bank locations are in fact part of one bank and that the deposits held at each office are not separately insured.

Certification & Authorization*

I have read the disclosures and acknowledgements above and agree to the terms and conditions that are stated within them by Heritage Bank.

Phone

This field is for validation purposes and should be left unchanged.

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Personal Savings Application