Consumer Deposit Account Application

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.


Are you applying for an individual or joint account?

Primary Account Holder

Secondary Account Holder


Ownership type

If payable on death, enter beneficiary information.

Opening Deposit

Additional Services

Check all that are of interest
Signature Card

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


By submitting this application, I certify that I/we 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 United Republic Bank's web site or delivered to the e-mail address I provide.