Personal New Account Application

Important Account Information

Please read through this Account Disclosure carefully. It contains information about the laws and regulations that affect your account with us. Please call us if you have any questions about the information presented here.

You must be 18 years of age or older to complete this form.

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 with us, we will ask 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.

When you submit an application with us, it must go through an approval process here at the bank. By submitting your application, you are not assured an account with us. If you submit an incomplete application for an Account, we cannot process the application or open the account until we have received all of the necessary information to complete the application. Any funds received for deposit will be held without being credited to an account or being credited interest until the application is completed and approved. If the application is not approved, the funds will be returned to you without interest.

Note: All transactions are secure. If using Internet Explorer, please verify the lock on the address bar before entering personal information.

Select Account Type
Individual Account Joint Account
Individual Account with POD Joint Account with POD
Other (explain) 

Applicant Information

Required fields are marked with an asterisk *

Applicant
First Name*
Middle Name
Last Name*
Physical Address*
City*
State*
ZIP/Postal Code*
Country*
Mailing Address
Mailing City
Mailing State
Mailing ZIP/Postal Code
Mailing Country
Social Security Number*
- -
Date of Birth*
(mm/dd/yyyy)
Home Phone*
Cell Phone
Mother's Maiden Name
Employment Status*
Company Name
Company Address
Work Phone*
E-mail*

Drivers License
Number*
Expiration Date
Issue Date
State*
Citizenship*

Best Time to Call*
Daytime
Evenings

Payable on Death Info
First Name
Middle Name
Last Name
Address
City
State
Zip
SS# - -
Date of Birth
Co-Applicant
First Name
Middle Name
Last Name
Physical Address
City
State/Province
ZIP/Postal Code
Country
Mailing Address
Mailing City
Mailing State
Mailing ZIP/Postal Code
Mailing Country
Social Security Number
- -
Date of Birth
(mm/dd/yyyy)
Home Phone
Cell Phone
Mother's Maiden Name
Employment Status
Company Name
Company Address
Work Phone
E-mail

Drivers License
Number
Expiration Date
Issue Date
State
Citizenship


Please open the following accounts:
Money Market Free Checking
Savings Student Checking
Super Eagle Kids Club Savings Ultimate Checking


Deposit Amount
Deposit Type
For ACH/Transfers, please fill in the below boxes
Bank
Routing Number
Account Number


Please select any additional product you may be interested in:
Debit Card Checks Wire Services Online Banking
Credit Card Insurance Consumer Loan Investments
eMobile Banking Travel Card Gift Card
Reloadable Card Direct Deposit eStatements
Online Bill Pay Telephone Banking


To indicate a change of address, please use the comments box below.
To reorder checks for your account, please indicate so in the Comments Box, providing your account number, ending check sequence number and the number of boxes requested.


Comments

Certification and Agreement

(1) The number(s) shown in this application is/are the correct taxpayer identification number(s) and I/we am/are not subject to backup withholding either because I/we have not been notified that I/we am/are subject to backup withholding as a result of failure to report all interest or dividends, or the IRS has notified me/us that I/we am/are no longer subject to backup withholding.

(2) by the IRS that I/we am/are subject to backup withholding due to notified payee underreporting and I/we have been notified that the backup withholding is terminated.

(3) I/we agree to be bound by the provisions of the applicable disclosure(s) for products I/we have selected. Reliabank will furnish such applicable disclosure(s) to me/us within the timeframe(s) prescribed by regulation and I/we will inform Reliabank if I/we do not receive full disclosure(s).

Intentionally submitting false information for the purpose of opening an account is considered a criminal activity. Systems have been implemented to identify attempts of fraud.