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USA Patriot Act

IMPORTANT INFORMATION ABOUT OPENING AN ACCOUNT

On September 11, 2001, our lives changed forever.  In an effort to protect you and our country, the USA PATRIOT Act was signed into law.  To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account.

When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you.  We may ask to see your driver’s license or other identifying documents.

We proudly support all efforts to protect and maintain the security of our customers and our country.

 

Personal Deposit Application

Type of Account
Initial Deposit Amount

1st Signer

Name:    
Street Address:    
City:    
Mailing Address:    
City:    
State:    
Zip:    
Home Phone: Work Phone:
Social Security #    
Occupation:    
Employer:    
Birth Date: Birth Place:
Mothers Maiden Name:    
Drivers License
or ID#
   
State Issued:    
Date Issued     
Date of Expiration    
       
Account Formerly With: Chexsystems Record:

2nd Signer

Name:    
Street Address:    
City:    
Mailing Address:    
City:    
State:    
Zip:    
Home Phone: Work Phone:
Social Security #    
Occupation:    
Employer:    
Birth Date: Birth Place:
Drivers License or ID# Mothers Maiden Name:
State Issued:    
Date Issued     
Date of Expiration    
       
Account Formerly With: Chexsystems Record: