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Application For A New Personal 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 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.
This application document acts as the signature card for the account.
For interest bearing accounts only: The interest rate you will receive on your account
is established at the time of the Bank’s acceptance of a completed and approved
application along with our receipt of funds for the opening deposit.
Do you have a question? You can call us toll free at (866) 762-2788. We are
open Monday through Friday between 8am - 6pm Pacific Time. Or feel free to visit
one of our Financial Centers.
Basic Information
(Select only one)
Personal Net Certificate of Deposit (CD)
Days
Months
Personal Net Individual Retirement Account (IRA)*
Days
Months
* Please call us so we may mail you the necessary forms.
(Select only one)
Automatically Compound to CD
Direct ACH Credit to an account at another financial institution (*)
(*) Please attach a voided check for account verification.
Initial Deposit $
By:
Wire
Mail
In Person
(Please indicate)
Individual
Joint
Trust
(Please indicate)
Tenancy in common account
Community property account of husband
and wife
Joint account of husband and wife
with right of survivorship
(Please indicate)
Formal Trust - Certification of
Trust form required*
Totten Trust **
Pay-On-Death **
** For this type of trust account, please provide the name, social security number
and address of beneficiary:
Agreements
For each account holder, please complete
print, sign and mail the Customer Information Profile and submit with this application.
 Customer Information Profile
For a Formal Trust account, please complete
the Certification of Trust form.
Certification of Trust For Deposit Accounts
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Applicant Backup Withholding Certification
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My correct Social Security Number is shown below.
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I am not subject to backup withholding because either I have not been notified of
being subject to backup withholding as a result of failure to report all interest
or dividends, or the IRS has notified me that I am no longer subject to backup withholding.
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I am an exempt recipient under the Internal Revenue Service (IRS) Regulations.
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I am not a citizen or a resident of the United States. Nonresident aliens must complete
and remit IRS Form W-8BEN (click link to download this form from the
IRS.)
Tax Payer ID Number / Social Security Number:
Under penalties of perjury, I certify that (1) the social security number indicated
above is my number and (2) I am not subject to backup withholding as a result of
failure to report all interest or dividends, or the IRS has notified me that I am
no longer subject to backup withholding, (3) I am a U.S. Citizen (includes a U.S.
resident alien). You must cross out item 2 above if you have been notified by the
IRS that you are currently subject to backup withholding because you have failed
to report all interest and dividends on your tax return.
Applicant Signature: _____________________________________________ Date: ___________
Information
I understand that this is an application for an account with Pacific Mercantile
Bank and is subject to approval. Everything that I have stated in this account application
and applicable agreements is/are correct to the best of my knowledge. You are authorized
to verify credit, employment history, inquire into past banking relationships and/or
order a credit report form a credit reporting agency. My signature must be on file
before the account can be opened.
All authorized account holder signatures must be present on this form:
Applicant Signature:
Printed Name: _________________________________________ Date: ___________
Co-Applicant Signature:
Printed Name: _________________________________________ Date: ___________
Instructions
In addition to the signed application, you will need to send copies of all documents
that are needed to identify you.
- Please include a legible copy of your driver’s license.
- Although we will send mail to a PO Box, we do need your physical street address
on file.
- For a trust account, please provide the Certification of Trust form with this application.
Without proper documentation your account will not be opened/or will be closed
and the funds returned without interest.
Pacific Mercantile Bank
Central Operations/CD Desk
949 South Coast Drive, 3rd Floor
Costa Mesa, CA 92626
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