Commercial Account Application Form

Business Name*

DBA

Address (Business Location)*

City*

State*

Zip*

Business Mailing Address(if different from above)

Business Mailing City

Business Mailing State

Business Mailing Zip

Business Phone*

Business Fax

Articles of Incorporation

State

Expires

Tax ID Number

Type of Business

Date Established

County Organization

State


Ownership
Sole Ownership
Corporation
Partnership
Organization
Non-profit Organization
Limited-Liability Corporation/Partnership


Type of Account
Checking
NOW Account
Money Market
Savings
Certificate of Deposit
Safe Deposit Box

Type of Customer
Retail
Wholesale
Other


Expected Transactions
Currency
$
Check Dep
ACH
Wire Transfers
   Frequency
   Expected Amount
Foreign Wires
   Country

Please complete the following information for each signer on the account. For the driverŐs license or state ID card information, record the number, issuing state and expiration date.

First Account Signer:
First Name*

Last Name*

Personal ID

Personal ID Value

SSN*

Home Phone Number*

Birth Date

Birth Place

Email Address*


Request Online Banking Access for this Account?
Yes
No


Second Account Signer:
First Name

Last Name

Personal ID

Personal ID Value

SSN

Home Phone Number

Birth Date

Birth Place

Email Address


Request Online Banking Access for this Account?
Yes
No


Third Account Signer:
First Name

Last Name

Personal ID

Personal ID Value

SSN

Home Phone Number

Birth Date

Birth Place

Email Address


Request Online Banking Access for this Account?
Yes
No


Fourth Account Signer:
First Name

Last Name

Personal ID

Personal ID Value

SSN

Home Phone Number

Birth Date

Birth Place

Email Address


Request Online Banking Access for this Account?
Yes
No



FDIC
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