IMPORTANT
Please read these directions before completing this Application, and select the appropriate item below:*IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT
To help the government fight the funding of terrorism and money laundering activities, the USA Patriot Act 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 for your name, physical address, date of birth, taxpayer identification number and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents. We will let you know If additional information is required.
SECTION A - INFORMATION REGARDING APPLICANT
IF U.S. PERSON (Complete all that apply)
IF NON-U.S. PERSON (Complete all that apply)
Additonal Applicant Information
Present Employer
Previous Employer
Income
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation
Alimony, child support, or separate maintenance received under:
Nearest Relative not living with you:
COVERED BORROWER IDENTIFICATION STATEMENT
Warning: It is important to fill out this form accurately. Knowingly making a false statement on a credit application is a crime.
By signing or electronically signing below, I certify that the box checked above accurately represents my current status as a covered borrower under the John Warner National Defense Authorization Act.
SECTION B - INFORMATION REGARDING CO-APPLICANT
IF U.S. PERSON (Complete all that apply)
IF NON-U.S. PERSON (Complete all that apply)
Additonal Applicant Information
Present Employer
Previous Employer
Income
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation
COVERED BORROWER IDENTIFICATION STATEMENT
Warning: It is important to fill out this form accurately. Knowingly making a false statement on a credit application is a crime.
By signing or electronically signing below, I certify that the box checked above accurately represents my current status as a covered borrower under the John Warner National Defense Authorization Act.
SECTION D - ASSET & DEBT INFORMATION
All Applicants complete this section. If there is more than one applicant, mark Primary Applicants Information with an A. If Section B was not completed, only give information about the Applicant in this Section.
Automobiles
Cash Value of Life Insurance
Real Estate
Marketable Securities
Other
IF U.S. PERSON (Complete all that apply)
IF U.S. PERSON (Complete all that apply)
Auto Insurance
Properties
Co-Owners (list all)
SIGNATURES
Everything that I have stated in this Application is correct to the best of my knowledge. I understand that you will retain this Application whether or not it is approved. You are authorized to check my credit and employment history and answer questions about your credit experience with me. Unless I have purchased the insurance product(s) by mail or if the Credit Disclosures are provided electronically, by signing below, I acknowledge that I have received the Credit Disclosures orally at the time I applied for credit and fully understand the disclosures noted above. I am also being provided with a copy of these disclosures and I acknowledge receipt by my signature.
CREDIT DISCLOSURES: An insurance product or annuity may be offered to you. If you purchase an insurance product or an annuity: (1) The insurance product or annuity is not a deposit or other obligation of, or guaranteed by, this institution or our affiliate(s); (2) With exception of Federal Flood Insurance or Federal Crop Insurance, the insurance product or annuity is not insured by the Federal Deposit Insurance Corporation or any other agency of the United States, this institution, or our affiliate(s); and (3) In the case of an insurance product or annuity that involves an investment risk, there is investment risk associated with the insurance product, including the possible loss of value. If an insurance product or annuity is offered we cannot condition an extension of credit on either of the following: (1) Your purchase of an insurance product or annuity from us or any of our affiliates; or (2) Your agreement not to obtain, or a prohibition on you from obtaining, an insurance product or annuity from an unaffiliated entity.
