Opt In Form

Please fill out the form below and list the account(s) that you would like to opt in or out of the Overdraft Service Program. All information submitted is secure and will be used only by Citizens National Bank. An asterisk (*) indicates required information.

Opt In

Name

First

Last

Date of Birth

Last four digits of your Social Security Number

Today's Date

Please enter your checking account number(s) with debit card access for which you want or do not want overdraft service. If you are entering multiple checking account numbers, press enter or return after each entry.*

Opt in?

I WANT Citizens National Bank to authorize and pay overdrafts on my ATM and everyday debit card transactions. (Opt in)

I DO NOT WANT Citizens National Bank to authorize and pay overdrafts on my ATM and everyday debit card transactions. (Opt out ATM/Debit Card)

I understand that this overdraft protection applies only to my consumer checking accounts with debit card access. Business accounts are not affected. I also understand that I have an ongoing right to change this consent at any time.

If you are human, leave this field blank.