Consumer Account Application

To help the government fight the funding of terrorism and money laundering activities, the USA Patriot Act requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: when you open an account, we will ask for your name, physical address, date of birth, and tax payer identification number (Social Security #) and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. We will let you know if additional information is required.


Are you signing individually or with a co-signer?

Primary Account Holder

Joint Account Holder


If payable on death, enter beneficiary information

If Agent/ Authorized Signer, enter their information

Account Preferences

What types of banking services do you expect to use at our financial institution on a monthly- basis? Fill out to the best of your ability. This is to help us get an idea of the type and amount of activity on your account.

Does the source of any of your funds come from a hemp related business(es) or product(s)? This includes but is not limited to: general retail sales of CDB Oil, Dispensary Sales of CBD oil, Pharmacy Sale of CBD oil, Online sales of CBD oil and Hemp producers of fibers, textiles, seed, meal, oil, imports or exports.
Does the source of any of your funds come from a marijuana related business(es) or product(s)? This includes but is not limited to: adult or medical use, retail, processing, cultivation, testing, operations that support marijuana businesses, landlords of a marijuana business, etc.

Signature Card

We will contact you upon receiving your application to schedule a time that is convenient to finish account opening procedures.

Which branch would you like to come into and sign signature cards?

Additional Requests

I have additional questions or requests


By submitting this application, I certify that I gave truthfully and fully provided the information required and that I am at least 18 years of age and live in the U.S.

By signing below, I authorize you to check my credit account and employment history and/or have a credit reporting agency prepare a credit report on me. I also authorize you to take steps to verify my indentity.

The purpose of this questionnaire is to begin the application process. All applications are subject to approval.

By entering my name below, I hereby give the electronic equivalent of my signature.