APPLICATION FOR NEW ACCOUNTS

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.

Type of Account:

 
Classic Checking Business Analysis Checking
 
Secure Checking Regular Savings
Hometown 50 Checking Christmas Club Savings
Hometown 50 + Checking Open-End IRA Savings
Now Account Certificate of Deposit
Money Market
Executive Money Market
Simply Business Checking
Simply Business Interest Checking

Primary Account Owner Information:

Name: (First/Middle/Last)
DOB: (MM/DD/YYYY) SSN: 
Address:
City: State:  Zip: 
Home Phone Number: Work Phone Number:
Employer:
Drivers License Number: State:  (Please provide copy)
Email Address:

Joint Account Owner Information (if applicable):

Name: (First/Middle/Last)
DOB: (MM/DD/YYYY) SSN: 
Drivers License Number: State:  (Please provide copy)

Comments/Instructions:

 

______________________
Signature

 

___________
Date

 

______________________
Signature

 

___________
Date

Note: All account owners must sign.

Print and sign completed application. 
Mail or Fax signed application to BNA Bank.

Fax: 662-842-9155 (Belden); 662-534-6702 (New Albany)

BNA Bank
P.O. Drawer 811
New Albany, MS 38652  

 

______________________________

 

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Approved

Date

       
   

______________________________

 

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  Disapproved Date