Certificate of Deposit 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

Account Information

Certificate of Deposit Type Account Duration

Primary Account Holder Information

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 Information

Are you applying for an individual or joint account?

Individual
Joint

Ownership

Ownership type

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

Beneficiary Information

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

 Add Another Beneficiary

Opening Deposit

Deposit Amount

Deposit Type

Check
ACH
Wire Transfer
Cash

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