Existing customers of Vinton County National Bank and Ross County Banking Center may print and mail this application. If you are not currently a customer, please visit one of our offices nearest you.

Social Security Number:___________________________ Date of Birth:_________________________

E-mail Address:__________________________________ Mother’s Maiden Name:_________________

Address:_____________________________________________________________________________

Home Telephone #:___________________________Work Telephone #:_________________________

Please list all account numbers on which you are a signer and would like to access. (All accounts must
have the same Owner and Tax Identification Number.)

__________________    __________________     __________________     __________________

   __________________    __________________     __________________     __________________

By signing below, I certify that the information is true and correct. I acknowledge that in consideration of Vinton County National Bank or Ross County Banking Center accepting this account and any other account(s) or service(s) whether existing or new, I agree to be bound by the Truth In Savings, Electronic Funds Disclosure, and other disclosures governing such account(s) or service(s), as amended from time to time and any other account opening documentation executed by me with the bank. All instructions delivered by Online access will be deemed to be my written authorization to charge or credit my accounts for transactions indicated. If I am under the age of 18, the undersigned parent/guardian agrees to be bound by the above on my behalf.

Account Owner’s Signature

___________________________________ _____________________________________
                               Signer                                       Parent/Guardian (if applicable)