Consumer Deposit Account Application

* = required fields

Important Information About Procedures For Opening A New Account :

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.

 

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:
*2nd ID Type:      *ID #:      *Expiration Date:
*Home Phone:      Cell Phone:       Work Phone: 
*Birth Date:      *Mother's Maiden Name: 
*Occupation: (if “none” or “retired”, indicate as such)       *Employer: 

Are you a senior political officer, or an immediate family member, or a close associate of one?    Yes      No


Joint Account Holder Information (if applicable)
First Name:      Middle Initial:      Last Name:
Social Security Number:
Drivers License Number:       State Issued:
Date of Issuance:      Date of Expiration:
2nd ID Type:      ID #:      Expiration Date:
Home Phone:      Cell Phone:       Work Phone: 
Birth Date:      Mother's Maiden Name: 
Occupation: (if “none” or “retired”, indicate as such)      Employer:

Are you a senior political officer, or an immediate family member, or a close associate of one?    Yes      No


Address Information
*Street Address:      *City:      *State:      *Zip:
Email Address:

 


Mailing address if different from above:
Mailing Address:      City:      State:      Zip:
Ownership: Single Owner (individual)
Joint (with right to survivorship)
Joint (with no right to survivorship) 
Payable on Death
If Payable on Death, Name and Address of Relation...
Name (First, Middle, Last):
Street Address:       City:      State:       Zip:
Opening Deposit  
Deposit Amount:      Deposit Type:
Account Preferences
ATM/Visa Debit Card
Taxpayer Identification
I am not subject to backup withholding, because I am exempt from backup withholding, or because I have not been notified by the IRS that I am subject to backup withholding as a result of failure to report all interest or dividends, or because the IRS has notified me that I am no longer subject to backup withholding.
I am subject to backup withholding.
I am not a United States citizen or resident.
I certify under penalties of perjury that the statements contained in this section are correct.
  By submitting this application, I/we certify that I/we gave truthfully and fully provided the information required and that I/we am at least 18 years of age and live in the US. I/we agree that I may receive electronic communications posted on the Pacific Alliance Bank Web Site or delivered to the e-mail address I/we provide, including information required by various laws and regulations. I/we authorize Pacific Alliance Bank to access my credit bureau information, check my employment, obtain reports from consumer reporting agencies and report to credit reporting agencies Pacific Alliance Bank's experience with me.

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