Registration for Commercial Trust NetTeller is required.
1. Complete all fields.
2. Print this form by using the PRINT button on your browser.
3. Sign the form.
4. Mail it to us at:
Commercial Trust Company
Attn: Commercial Trust NetTeller
119 North Main, P.O. Box 471
Fayette, Missouri 65248-0471
If you have questions about the application process, please contact us at 660-248-2222.
| Account Information | |||
| Name: | Social Sec. #: | ||
| Address: | Apt#/Suite: | ||
| City: | State: | ||
| Zip Code: | |||
| Home Phone: | Daytime Phone: | ||
| Checking Acct#: | Savings Acct#: | ||
| Mother's Maiden Name: | E-Mail Address: | ||
| If account is jointly held and co-owner wishes to use this service, the co-owner must complete the registration process as well. | |||
Government regulations require that we make the following disclosures available to you when you apply for an account with Commercial Trust Company. You may print these disclosures for your files.
Disclosures (will open new window)
By signing below, I am applying for Commercial Trust NetTeller. I authorize you to charge my account for any transactions accomplished through the use of Commercial Trust NetTeller, including the amount of any recurring payment or transfer that I make. I agree to comply with all of the above disclosures. In addition, I acknowledge that I have read and understand the Regulation E disclosures provided.
I agree that sufficient funds must be available in my account on the date I schedule payments or transfers to be made using the Commercial Trust NetTeller.
If the account(s) designated for this service are joint accounts, both account owners must sign this application
| Applicant Signature: | |
| Co-Applicant Signature: | |
| Date: |