Forms
Do you need a form? Download it here.

Many of our commonly used forms are available online in PDF format. To view these forms you will need Adobe Acrobat Reader. Once you have downloaded Acrobat Reader, please click on any of the forms below.

• Already a customer but haven't taken advantage of our FREE bill payment service yet? Complete the Bill Payment Service Enrollment form to get started! Be sure to read the Bill Payment Agreement when enrolling in this service.

Do you want a quick and easy way to make deposits to your Ascencia account? Transfer money electronically from your accounts at other banks to your Ascencia account after filling out the ACH form. Fill out the Wire Transfer Request if your money needs to be there today.

• Set up a single or recurring ACH deposit authorization with the Cash Transfer Authorization (ACH) form.
• Complete the Wire Transfer Request form to authorize Ascencia to initiate a domestic wire from your Ascencia account. If you are requesting an international transfer, please fill out an International Wire Request. Please keep in mind that charges may be applied to your account for initiating the wire transfer. Transfers must be initiated before 4:30 pm EST on a given business day. See our Service Fees for additional details.
• Cancel previously authorized but not yet completed single or recurring ACH deposit authorization with the Cancel Cash Transfer Authorization form.

If you need to stop payment on a check or electronic debit, please contact our Customer Service Team by email at support@ascencia.com or by phone at 1-877-3MYBANK (369-2265) as soon as possible. Our Customer Service Team can take your call from 8:00am to 5:00pm EST Monday through Friday.

• After speaking with a Customer Service Representative, complete the Stop Payment Request form and mail or fax it to us. See our Disclosures for additional details.

• If you believe that someone has used your card without your permission, please contact us as soon as possible. We may ask that you print and complete the Disputed Transaction Affidavit form for our records.

• Have you lost your ATM/Debit card? Need to request an additional card? Can't remember your PIN? If you have lost your card or believe that someone may have used your card without your authorization, please call us at 1-877-3MYBANK (369-2265). Our Customer Service Team can take your call from 8:00am to 5:00pm EST Monday through Friday . To request a new or an additional card, please complete the ATM/Debit Card Add or Change Request form and mail or fax it to us.

• Do you need to add another owner to your account? Has your name changed and you need to re-title your account? Complete the Add/Change/Remove Owner form and mail or fax it to us.

• Do you need to add or remove an authorized signer on your business account? Complete the Add/Remove Authorized Signer form and mail or fax it to us.

• Would you like to add a Payable on Death beneficiary to your account? Please complete the Payable on Death Agreement and mail or fax it to us.

• If your Certificate of Deposit (CD) is at maturity or about to mature and you wish to close it, please complete the CD Redemption form. Please indicate how you would like the funds to be remitted.

• If your Certificate of Deposit (CD) is at maturity or about to mature and you wish to change the term and/or deposit amount, please complete the CD Renewal form. Please indicate how you will remit the additional funds. To request funds from your maturing CD and allow the remainder to renew, please indicate the amount requested and how the funds should be sent to you. Please note: In order to comply with the USA Patriot Act, we may need additional identifying information from you prior to processing your renewal.

• If you are the beneficiary named on the Certificate of Deposit and wish to close the account, please complete the Owner's Deceased form and mail to us along with all other required documents. Please note: We will need one form for each beneficiary listed on the account.

• The Corporate Resolution should be completed by our customers whose accounts are titled in the name of a Corporation.
• Complete the Business Resolution for all other business entities, including LLCs, Partnerships and non-profit associations.