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Simplify Your Life
Simplify Your Life
Switch to Central Bank
www.centralbank.net 573-634-1234
To complete account opening, please print and bring this information with you to any of Central Banks locations.
Additional forms will need to be signed in person by both the primary and joint account holder.
You will need to bring your valid drivers license, passport, or military I.D., plus additional forms of identification.

Individual Account Holder
Joint Account Holder
Name
Name
Address
Address
City, State, Zip
City, State, Zip
Home Phone
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Email Address:
Email Address
Drivers License Number, State, Expiration Date
Drivers License Number, State, Expiration Date
SSN
SSN
Date of Birth
Date of Birth
Employer
Employer
Occupation
Occupation
Account Application Simplify Your Life
Switch to Central Bank
www.centralbank.net 573-634-1234
Current Direct Deposit
Old Financial Institutions
Account Number
Routing Number
Amount
Redirect my direct deposit to:
Central Bank
Account Number
Routing Number
Amount
086500634
086500634
To:
Company Name





Attn:
Company Address





City, State, Zip
From







Employee SSN
Employee I.D.






Department Name
Home Address






City, State, Zip
Work Phone






Home phone
I authorize you to change my Payroll direct deposit to my new Central Bank account effective beginning
_______________________ (please allow 3 to 4 weeks).
Authorization to Change Direct Deposit
Authorized signature____________________________________________ Date______________________
(Date) Simplify Your Life
Switch to Central Bank
www.centralbank.net 573-634-1234
Previous Bank ________________________________________________
Address ______________________________________________________
City____________________________State__________ Zip____________
From:
Primary Account Holders Name _______________________________
Primary Social Security Number_______________________________
Secondary Account Holders Name_____________________________
Address____________________________________________________
City__________________________State_____________Zip___________
Account Closing Form
Please forward funds according to closing date to:
Central Bank
Attn: ___________________________(employee name)
c/o ____________________________(customer name)
PO Box 779
Jefferson City, Mo 65102
Please close the following accounts
Account Type
Account Number*
Check here to
send payment
immediately*
Special
Instructions
I authorize you to close the accounts listed above and to forward funds to Central Bank.
Primary Account Holder Signature
Secondary Account Holder Signature
Date
*Please make sure all checks and all automatic debits have been switched prior to closing your account.
We recommend viewing two months statements to ensure you have switched them all. Simplify Your Life
Switch to Central Bank
www.centralbank.net 573-634-1234
Automatic Payment Switch Form
Merchant or Utility Name__________________________________
Address_________________________________________________
City __________________________State_________ Zip__________
Merchant or utility account number_________________________
Financial Information
Please redirect my automatic withdrawal from my old account:
Bank Name_____________________________________________
Account No. ____________________________________________
Routing No. ____________________________________________
From:
Customer Name_________________________________________
Address _________________________________________________
City_______________________State__________ Zip ____________
To be withdrawn from new account at Central Bank:
Account No.__________________________
Routing No. 086500634
Amount of withdrawal_______________
Effective Date ________________________
I, _________________________ (print name), authorize you to redirect payment from my old account to my new
account effective ________________. If you have questions, please contact me at the following phone number ______
________.
Authorized Signature___________________________________________________ Date__________________
Please complete a new form for each automatic withdrawal you are switching. To save time and
money, stop by any Central Bank location for assistance in completing your forms. We will make it
simple by completing the switch and mailing the forms to the address you listed. Postage is on us!
Thank you for choosing Central Bank.