* - Indicates required fields
General
Type of Account *
Select Account Type
Money Market DDA
NOW Checking
Regular Checking
Savings
Super NOW Checking
Ownership of Account *
Select Ownership Type
Corporation
Estate Account
Formal Trust
Limited Liability Partnership
Limited Liability Company
Non-Profit Corporation
Partnership
Sole Proprietorship
Please note: profit organizations or entities (such as corporations, partnerships, limited liability companies, business trust, etc.) are not eligible for NOW or Super NOW accounts.
Business Information
Name of Business *
EIN *
Business Type *
Business Phone Number *
Cell Phone Number *
Street Address *
City *
State *
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
DC
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code *
Does this business perform check cashing or money transfers? *
Does this business perform sales of money orders or lottery tickets? *
Does this business engage in unlawful internet gambling? *
Account Preferences
Check all that apply
Commercial Customer Due Diligence Questionnaire
Describe your products and services *
How long have you owned this business?
Years *
Months *
How long have you managed this business?
Years *
Months *
What percentage of your gross revenue is derived from money services (for example, check cashing, selling or redeeming travelers checks, money transmission)? *
List each of your owned business locations below (physical address)
Describe your USA Market Area and customer base.
Check all that apply
Please describe your primary target market and any other customer groups to whom you market your services to. *
What type of state business license do you hold?
Does the business process any transactions on behalf of another entity or individual? *
Please Explain *
Which of our branches do you intend to use to conduct business?
Check all that apply
Does the source of any of your funds come from a hemp related business(es) or product(s)? *
Please explain your involvement with hemp *
This includes but is not limited to: general retail sales of CDB Oil, Dispensary Sales of CBD oil, Pharmacy Sale of CBD oil, Online sales of CBD oil and Hemp producers of fibers, textiles, seed, meal, oil, imports or exports.
Does the source of any of your funds come from a marijuana related business(es) or product(s)? *
Please explain your involvement with marijuana *
This includes but is not limited to: adult or medical use, retail, processing, cultivation, testing, operations that support marijuana businesses, landlords of a marijuana business, etc.
Do you have any Automated Teller Machines (ATMs) installed at any of your business locations? *
What types of banking services do you expect to use at our financial institution on a monthly basis?
Fill out to the best of your ability. This is to help us get an idea of the type and amount of activity on your account.
Banking services you expect to use at our financial institution on a monthly basis
Access *
Select Access Type
Weekly
Monthly
Quarterly or Less
Signature Card
We will contact you upon receiving your application to schedule a time that is convenient to finish account opening procedures.
Which branch would you like to come into and sign signature cards? *
Additional Requests
I have additional questions or requests *
Please Explain *
Acknowledgement *
*
Endorsement
By submitting this application, I certify that I gave truthfully and fully provided the information required and that I am at least 18 years of age and live in the U.S.
The purpose of this questionnaire is to begin the application process. All applications are subject to approval.
By entering my name below, I hereby give the electronic equivalent of my signature.
Business Representative Signature *
Date
