New Account Application – Business

Account Types Business Checking Business Select Checking Business Platinum Checking Business Money Market Business Savings Business Debit Card Business Certificate of Deposit (CD)

Business

Business Name Tax Id Number (TIN)

Street Address

Street Address (physical address) City State Zip Code Mailing address is different than street address.

Mailing Address

Mailing Address City State Zip Code

Contact Information

Primary Phone Number Alternate Phone Number E-mail Address Website

Nature of Business & Categorization

Nature of Business (construction, manufacturing, agriculture) NAICS Code (naics.com) Business Type (e.g. DBA, LLC, C Corp, S Corp, Organization)

Primary Contact

First Name Middle Name Last Name Suffix Title

ID

Social Security or Tax ID Number Birth Date Mother’s Maiden Name Driver’s License Number State Date of Expiration

Street Address

Street Address City State Zip Code Mailing address is different than street address.

Mailing Address

Mailing Address City State Zip Code

Contact Information

Primary Phone Number Alternate Phone Number E-mail Address

Authorization

In accordance with the USA Patriot Act, our financial institution is required to obtain, verify and record information that identifies each person that has an account. We will ask your name, address, DOB, SSN and other information, including but not limited to a current, non-expired picture identification. We support all efforts to protect and maintain the security of our customers and our country.

Our financial institution verifies all account applicants with eFunds ChexSystems and OFAC.

We reserve the right to deny this application.

Per bank policy, Mid America Bank reserves the right to close any/all accounts if proper documentation is not received within 30 days of opening.

Yes, I agree to the Terms and Conditions