NEW ACCOUNT APPLICATION

IMPORTANT ACCOUNT OPENING INFORMATION: Federal Law requires us to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.


Customer Signature	Signature Date		Customer Signature	Signature Date

I certify that everything that I have stated in the application and on any attachments is correct. You may keep this application whether or not it is approved. By signing above I authorize you to check my credit account and employment history and/or have a credit reporting agency prepare a credit report on me, as an individual. I also authorize you to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes.

DATE:

TYPE OF ACCOUNT:

Regular Checking	Business Checking	Image Free
Thrifty Checking	Small Business Checking	Magnolia Savings
Money Market	Organization Checking	Youth Savings
Magnolia Circle	Student Checking	Silver Savings
Magnolia Prime	Government Checking	Christmas Club
Now Checking	Generation Gold	Cash Management

PRIMARY OWNER:
SECONDARY OWNER:
ADDRESS:

CITY:	STATE:	ZIP + 4:
COUNTY:
PRIMARY SSN:	SECONDARY SSN:
PRIMARY TAX ID :	SECONDARY TAX ID:
PRIMARY DL NO:	SECONDARY DL NO:
PRIMARY DOB:	SECONDARY DOB:
PRIMARY EMAIL:	SECONDARY EMAIL:
PHONE: (H)	PHONE: (W)
PHONE (C)
EMPLOYER:

DEPOSIT AMOUNT:

CHECK

CASH

NEW CUSTOMER:	Yes No	IN-HOUSE TRANSFER:	Yes No
REOPEN EXISTING ACCOUNT:	Yes No	ACCOUNTY DENIED:	Yes No
VERIFIED OFAC LIST:	Yes No	DATE:
ACCOUNT #		SERVICE CHARGE:	Waive Charge
OPENED BY:		BRANCH: