New Account Application
First Name
Middle
Last
Date of Birth
Home Address (street)
City
State
Zip Code
E-mail Address
Mailing Address (if different)
City
State
Zip Code
E-mail Address
Telephone
Years at Present Address
Social Security No. or Federal ID
Drivers License No.
State License Issued In
Previous Home Address (If less than one year)
Years There
Firm Name or Employer and Position
Telephone
Address (street)
City
State
Zip Code
Name and Address of Nearest Relative not living with you, that we may contact, who will know your whereabouts at all times.
Telephone
Co-Applicant
Date of Birth
Drivers License No.
State License Issued In
Social Security No.
Home Address (street)
City
State
Zip Code
E-mail Address
First Employment
Position
How Long
Business Phone
Nearest Relative Not in Household
Relationship
Address
City
State
Please Select the Accounts you would like to open
Checking Accounts Savings Account
Community Checking Regular Savings
Regular Checking Christmas Club
Business Checking Vacation Club
Small Business Checking Certificate of Deposit
  Individual Retirement Account
Interest Bearing Checking Accounts  
Reward Checking  
Now Account  
Money Market Account  
Customer Information Policy and Privacy Policy
To help the government fight the funding of terrorism & money laundering activities, federal law requires all financial institution to obtain, verify, and record information that identifies each person who opens the account. What this means for you: When you open an account we will ask for your name, address, DOB, and other information that will allow us to identify you, such as your drivers license or other identifying documents. Privacy - UCB does note disclose any non-public personal information about you to anyone, except as permitted by law.
Applicants Signature
By completing the above, I am providing information for the purpose of obtaining an account and I authorize United Community Bank to obtain information concerning any of the statements I have made. I also authorize United Community Bank to make inquiries they feel are necessary to determine my credit worthiness including, but not limited to obtaining credit reports from credit reporting agencies and other credit information from other sources.

I understand that this application is subject to United Community Bank approval. Fax the completed application to (225) 644-0402, attention Customer Service; upon approval, you will be contacted to sign documents for the new account. You may also deliver the completed application in person to any United Community Bank Branch. You may also mail the completed application to attention Customer Service, P.O. Box 850, Gonzales, LA 70707-0850

Applicants Signature     

Co-Applicants Signature