Checking & Savings Account Application

Important Information About Procedures For Opening A New Account

(PATRIOT ACT) 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.

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

Required Field

General

Account Type

Simple Checking
Rewards Checking
Interest Checking
Regular Savings
MMDA
Diapers to Diplomas

Are you applying for an individual or joint account?

Individual
Joint

Primary Account Holder

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mother's Maiden Name Driver's License Number State Issued Date of Expiration Date Issued Street Address City State Zip Code Mailing address is different than street address. Mailing Address City State Zip Code

I am a United States citizen or resident.

Are you involved in any marijuana related business activities?

Are you involved in any hemp related business activities?

Home Phone Number Work Phone Number E-mail Address Occupation Employer Name

Joint Account Holder

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mother's Maiden Name Driver's License Number State Issued Date of Expiration Date Issued Street Address City State Zip Code Previous Address City State Zip Code Home Phone Number Work Phone Number E-mail Address Occupation Employer Name

 Add Another Owner.

Ownership

Ownership type

Payable on Death
Single Owner (individual)
Joint (with right to survivorship)

If payable on death, enter beneficiary information.

Signer Only

First Name Middle Initial Last Name Suffix Birth Date Social Security Number Street Address City State Zip Code Relationship to holder

 Add Another Owner.

Opening Deposit

Deposit Amount

Deposit Type

Check
ACH
Wire Transfer
Cash

Additional Products and Services

Debit Card
ATM Card
Online Banking
Credit Card
Mobile Banking/Deposit
Would you like us to place a Check Order for you?

Would you like to extend Overdraft Privilege? (Covers ATM withdrawals and every day debit card transactions on your personal account)

We will contact you upon account approval to complete the account opening process

Certification

I certify under penalties of perjury that the statements contained in this section are correct.

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

Primary Account Holder's Signature Date

Joint Account Holder's Signature Date

 Add Another Owner.