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e-Banking Application

Applicant Information
Personal or Business

e-Banking and/or PowerPay Information

Business Name:
First Name:*
Middle Initial:
Last Name:*
Mailing Address:*
State & ZIP:* ,
Permanent Address:*
(no PO Boxes)
State & ZIP:* ,
Home Phone:*
Cell Phone:
Date of Birth:*
Social Security Number:*
Tax ID:*
Mother's Maiden Name:*
Email Address:*
Applicant Online Banking Information

Applicant Bill Pay Information
Checking account to pay bills from:


By typing, printing, signing, and/or submitting this application online, I/we certify that everything I/we have stated in this application is correct and agree to the terms indicated below. I/we understand that I/we will be contacted by a Bank representative to either complete the process or obtain additional information. I/we understand that additional information may be required for processing. I/we further understand that if the application is approved, I/we agree to receive all disclosures, provide identification, and sign agreements/documents in person at the time I/we visit the Bank. If the application is not approved, I/we agree to receive all disclosures by mail. I/we further understand that the Bank may also keep this "Jump Start" application whether or not an account opening results. I/we authorize you to check my/our credit (for loan requests only), verify current and previous bank account information, employment history, and any other information submitted with this application. For loans: I/we also agree to update credit information at the request of the Bank.

By using e-Banking through The Citizens National Bank, I agree to the terms and conditions included in the Online Banking agreement and such other terms and conditions or amendments thereto, as may be established by the Bank and communicated to me. I hereby authorize The Citzens National Bank to verify any information included in this application and allow access to all the accounts listed above on which I am an owner.

Online Banking Agreement & Disclosure

By checking this box and clicking the print and/or submit below, you agree that you have read and understand the Online Banking Agreement & Disclosure.

Electronic Statement(s)/Notice(s) Delivery Agreement and Disclosure

By checking this box and clicking the print and/or submit below, you agree that you have read and understand the Electronic Statement(s)/Notice(s) Delivery Agreement and Disclosure.

BillPay Disclosure

I AUTHORIZE Citizens National Bank to post payment transactions generated by PC from the Bill Paying Service to the account indicated on the form being sent electronically. If at any time I decide to discontinue service, I will provide written notification to Citizens National Bank. My use of the Bill Paying Service signifies that I have read and accepted all terms and conditions of the Bill Paying Service.

I UNDERSTAND that payments may take three to five (3 to 5) business days for electronic payee, and seven to ten (7 – 10) business days if the payee is paid by check. Citizens National Bank is not liable for any service fees or late charges levied against me. I also understand that I am responsible for any loss or penalty that I may incur due to lack of sufficient funds or other conditions that may prevent the withdrawal of funds from my account.

By checking this box and clicking the print and/or submit below, you accept these terms and conditions.

NOTE TO APPLICANT: By submitting this application to the Bank, you agree that you have read, understand and agree to the terms and information stated above. This application may be submitted by using ANY of the methods below.

SUBMIT online to immediately transmit electronically


PRINT & SIGN to fax/mail/drop by your application to one of our convenient locations. Applications may be faxed to: (860) 928-7558 or mailed to: Citizens National Bank , Attn: e-Banking Customer Service Center, 182 Main St, Putnam, CT 06260

Signatures necessary only for faxed/mailed/drop by applications.


Citizens National Bank Privacy Policy