APPLICATION FOR PERSONAL ACCOUNTS

Instructions For Filing Account Application: 

  1. Complete the application below. Please provide all requested information.

  2. Print the completed application and sign in the space provided. All account owners must sign.

  3. Copies of two forms of identification are required for each account owner. One of the ID's provided for each account owner must contain a photo, such as a driver's license or passport. Expired identification cards and copies of credit cards are not acceptable.

  4. Mail completed application with a photocopy of your two forms of identification together with your check for the opening deposit to:

    INTERVEST NATIONAL BANK
    One Rockefeller Plaza, Suite 400
    New York, NY 10020-2002

    OR   

    		 INTERVEST NATIONAL BANK
    625 Court Street
    Clearwater, FL 33756-5528


  5. The minimum deposit required to open a certificate of deposit is $2,500 ($1,000 for IRA CD's).
    The minimum deposit required to open a money market account and IRA money market account is $1,000.  We will open your account upon receipt of your deposit and the required copies of your identification. We cannot hold or guarantee rates. Rates are subject to change without prior notice. If you wish to check current rates, click here. 

  6. You may fax your application to us and have the funds sent via wire transfer if you wish to open your account immediately.  Funds received after 2 P.M. will be processed on the next business day. An incoming wire charge of $15.00 will be deducted from your opening deposit.
    Provide the following wiring instructions to your bank/broker:


    For New York Accounts (fax 212-218-8390):




    For Florida Division Accounts (fax 727-441-4784):




  7. We will send you the appropriate account documentation after your account is opened and the required account documentation is received by us. Failure to provide the required information may result in a delay in opening your account or your initial deposit may be returned.

Thank you for banking with Intervest National Bank.

 

 


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 all 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 will also ask to see your driver's license and other identifying documents so that a copy may be placed in your customer file for future reference. This information is not shared with anyone other than with Bank personnel who are required to know this information to service you account.


Select Account:

Choose Interest Option:

Savings
Checking
Money Market Account 
Certificate of Deposit     
Capitalize
Send Interest Check (minimum balance required $20,000)
  Monthly Semi-Annually
  Quarterly Annually
Credit to INB Account #:

ACH Interest Transfer

Select Type of Account

Single Owner Uniform Transfer to Minor Act Account
      NY or   FL
Joint (Right of Survivorship) Payable on Death to
Joint (No Right of Survivorship)  
Trust Under Agreement  

Primary Account Owner Information:

Name: (First/Middle/Last)
DOB: (MM/DD/YYYY) SSN: 
Address:
City: State:  Zip: 
Home Phone Number: Work Phone Number:
Occupation:
(If Retired, kindly indicate last occupation)
Employer:
Drivers License Number: State:  (Please provide copy)
Email Address:
Current Bank:
Bank Address:
Account #:

Joint Account Owner Information (if applicable):

Name: (First/Middle/Last)
DOB: (MM/DD/YYYY) SSN: 
Address:
City: State:  Zip: 
Home Phone Number: Work Phone Number:
Occupation:
(If Retired, kindly indicate last occupation)
Employer:
Drivers License Number: State:  (Please provide copy)
Email Address:
Current Bank:
Bank Address:
Account #:

Comments/Instructions:

Acknowledgement: By signing below, I (we) agree to the terms and conditions of your deposit accounts, Electronic Funds Transfer Disclosure, the Funds Availability Disclosure, the Truth in Savings Disclosure, the Service and Fees Schedule, the ATM User Precautions and acknowledge receipt of same. Please click here  
for complete disclosures.

I (we) understand that this is an application for an account with Intervest National Bank and is subject to approval. Such approval process may include a review of my (our) credit history, employment verification and an inquiry into my (our) past banking relationship. I authorize INTERVEST NATIONAL BANK to obtain a copy(ies) of my(our) current credit report, if required, as a  condition of acceptance of this account application. 


Signature
Date
Signature
Date

Substitute W-9 Certification:  Please read entire statement before signing.  Check all that apply.

Social Security Number(s): The Social Security Number(s) shown above is my correct SSN. 
Backup Withholding: I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding. 
Exempt Recipients: I am an exempt recipient under the Internal Revenue Service Regulations. 
Nonresident Alien: I am not a United States person, or if I am an individual, I am neither a citizen nor a resident of the United States. 

I certify under penalties of perjury the statements checked in this section are true. 


Signature of
Primary Account Holder
Date

                

SEE OUR DISCLOSURES