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Forms for former Ascencia Customers

Do you need a form? GET it here

Many of our commonly used forms are available online in PDF format. To view these forms you will need Adobe Acrobat Reader.

CD Redemption and Renewal Forms

CD Redemption form: If your Certificate of Deposit (CD) is at or near maturity and you wish to close it, please complete this form.

CD Renewal form: 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 this form. Please note: In order to comply with the USA PATRIOT Act, we may need additional identifying information from you prior to processing your renewal.

Owner's Deceased form: If you are the beneficiary or executor named for an Ascencia accountholder who has passed away, please complete this 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.

Change Request Forms

ATM/Debit Card Add or Change Request form: 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 1-877-369-2265.

Add/Change Owner form: Do you need to add another owner to your account? Has your name changed and you need to re-title your account?

Add/Remove Authorized Signer form: Do you need to add or remove an authorized signer on your business account?

Payable on Death Agreement: Would you like to add a Payable on Death beneficiary to your account?

Disputed Transaction Affidavit

Disputed Transaction Affidavit form: If you believe that someone has used your card without your permission, please contact us by phone at 1-877-369-2265 as soon as possible. After speaking with us, you will need to print and complete this for our records.

Resolutions

Business Resolution: If you are opening a business account, please complete this form to indicate who is authorized to sign on behalf of your organization. If you are updating an existing resolution and adding additional signers, please submit an Add/Remove Authorized Signer form along with the resolution.

Transfer Forms

Cash Transfer Authorization (ACH) agreement: Complete this if you would like to close your account and ACH funds to another bank or if you would like the interest on your CD to be sent via ACH.

Wire Transfer Request: Complete this to initiate a domestic wire from your PBI Bank account. Charges do apply; see our Service Fees for additional details. For same day processing, transfers must be initiated before 3:00 pm EST on a given business day.

International Wire Request: Complete this to initiate an international transfer from your PBI Bank account. Charges do apply; see our Service Fees for additional details. For same day processing, transfers must be initiated before 3:00 pm EST on a given business day.

 

STOP PAYMENT REQUEST

If you need to stop payment on a check or electronic debit, please contact our Customer Service Team by phone at 1-877-369-2265 as soon as possible or log in to your Online Banking account to submit.After speaking with a Customer Service Representative, complete the Stop Payment Request formand send in to us. See our Disclosures and Service Fees for additional details.

Is there a form you need but don't see here? Email us and let us know.

To view PDF documents, you must have Adobe Acrobat Reader installed on your computer. If you do not have that installed, visit www.adobe.com for information on how to do so.

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My Branch
Eastpoint
2500 Eastpoint Parkway
Louisville, KY 40223
502-499-4800

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