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 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.
* Indicates Required Information
CHECK ONE OR MORE OF THE ACCOUNTS BELOW TO APPLY FOR:
CHECK ONE OR MORE OF THE SERVICES BELOW TO APPLY FOR:
I certify that I am at least 18 years of age and I have accurately and fully completed all items on this application. Under penalties of perjury, I certify that:
Or check all that apply:
I have been notified that I am subject to backup withholding.
I am not a U.S. citizen or resident (complete W-8) form.
The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
Please note, this application is subject to verification and approval. In order for us to process your application correctly, we may need to contact you to verify some of the information or request additional documentation. When you submit this application, you certify that everything stated above is true and accurate. When you submit this application, you also agree that this Institution reserves the right to review your credit history through an authorized bureau.
If you have any questions, please contact us at 701-782-6295, or by e-mail at customerservice@bankofhazelton.net. By clicking below, I hereby certify that everything I have stated above is correct. You may keep this application whether or not it is approved. By clicking below, I authorize you to check my credit and employment history and verify other information which I have provided to you.