SponsorshipForm

Please complete all the applicable fields below. * Indicates mandatory fields.

First Name *

Valid First Name required

Last Name *

Valid Last Name required

Email *

Valid Email required must have @ included.

Phone *

Valid Phone required must be 10 digits number 0-9

Company (if applicable) (Optional)

Street (Optional)

City (Optional)

State/Province (Optional)

Zip code *

Valid Zip code required must be 5 digits number 0-9.

Product interest (Optional)

product_interest

Customer interest (Optional)

customer_interest

Customer Consent *

I authorize Citizens to contact me by email or phone.

Customer consent required.

Please return device to your bank representative to fill out section below:

Branch (max 5 characters) *

Eg. (NH123, MA245)

Valid Branch required must be 2 characters (A-Z) and 3 digits (0-9).

Notes (Optional)

Lead source *

Valid lead source required.

Campaign *

Valid Campaign required.

Enter Campaign Name *

Valid Campaign Name required.

Thank you!

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