New Account Application

Print Name (First)
(Middle)
(Last)
Date of Birth
Home Address (Street)
(City)
(State)
(Zip Code)
E-mail Address
Telephone
Years at Present Address
Social Security or Federal ID
Drivers License No.
State License Issued In
Previous Home Address
Years There
Employer
Position
Years There
Business Phone
Address (Street)
(City)
(State)
(Zip Code)
Current Financial Institution
How did you hear about us
Where would you like to open your account?
Name and Address of Nearest Relative Not in Household, that we may contact
Telephone
Co-Applicant Name
Date of Birth
Driver’s License No.
State License Issued In
Social Security Number
Employer
Position
Years There
Business Phone
Nearest Relative Not in Household
Relationship
Address

Please Select the Accounts you would like to open

Checking Accounts: Savings Accounts:
 Community Express Checking Regular Savings
Regular Checking ATM Savings
Express 50 Checking Christmas Club
Banclub Checking Vacation Club
Small Business Checking Certificate of Deposit
Commercial Checking Individual Retirement Account
Interest Bearing Checking Accounts:
Reward Checking
Now Account
Money Market Account

Customer Information Policy

In accordance with Section 326 of the USA Patriot Act signed October 26, 2001, Community is required to obtain a copy of documents used in identifying our new account customers and in identifying signatory individuals added to existing or new accounts. In some cases, identification will be requested for those individuals banking with the bank prior to the effective date of the customer identification requirements because original documentation was not obtained with the opening of the account, or the bank is unable to form a reasonable belief that it knows the identity of the existing customer. In all cases protection of our customer’s identity and confidentiality is the Bank’s pledge to you.

Applicants Signature

By completing the above, I am providing information for the purpose of obtaining an account and I authorize Community Bank to obtain information concerning any of the statements I have made. I also authorize Community Bank to make inquiries they feel are necessary to determine my credit worthiness including, but not limited to, obtaining credit reports from credit reporting agencies and other credit information from other sources.

I understand that this application is subject to Community Bank approval. Fax completed application to (985) 537-6414; upon approval, you will be contacted to sign documents for the new account. Or you can deliver the completed application in person to any Community Bank office.

Applicants Signature  
Co-Applicants Signature