ID TheftSmart Application Form

Contact Information

First Name

Last Name

Address Line 1

Address Line 2

City

State

ZIP

Main Phone Number

Email Address

First Citizens Account for Enrollment Checking Savings

Last 4 Digits of First Citizens Account Number

Acknowledgement

I acknowledge that my First Citizens account stated above will be deducted $8.00 on the last business day of each month for my enrollment in the ID TheftSmart™ Credit Monitoring Service. I understand that I may cancel my enrollment at any time by notifying First Citizens Bank in person, writing, email, or by phone.