COD 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

Please choose the type of account
you are applying for:
 
 

Primary Account Holder Information

First Name: *
Middle Initial:  
Last Name: *
Social Security Number: *
Drivers License Number: *
State Issued: *
Date of Issuance: *
Date of Expiration: *
Home Phone: *
Work Phone: * Ext:
Date of Birth: *
Occupation:  
Employer:  
Mother's Maiden Name: *
Email Address: *

Joint Account Holder Information (if applicable)

  Check here if there is a joint applicant
First Name:  
Middle Initial:  
Last Name:  
Social Security Number:  
Drivers License Number:  
State Issued:  
Home Phone:  
Work Phone:   Ext:
Date of Birth:  
Occupation:  
Employer:
Mother's Maiden Name:  
Email Address:  
Would you like to add another account owner?  

Address Information

Street Address: *
City: *
State: *
Zip: * -
Mailing address if different from above:  
Mailing Address:  
City:  
State:  
Zip:   -

Ownership

 
If Payable on Death, Name and Address of Relation
Name (First, Middle, Last):  
Street Address:  
City:  
State:  
Zip:   -
Social Security Number:  
Relationship:  
Percentage: *
Would you like to add another beneficiary?  

Opening Deposit

Deposit Amount: *
Deposit Type: *

Account Preferences

Taxpayer Identification

  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. I certify that I have read and agreed to all the Terms & Conditions, Disclosures and Privacy Policy. I agree that I may receive electronic communications posted on the Lamar National Bank web site or delivered to the e-mail address I provide, including information required by various laws and regulations. I authorize Lamar National Bank to access my credit bureau information, check my employment, and report to credit reporting agencies Lamar National Bank's experience with me.
 

We will contact you upon account approval to schedule a time that is convenient.