Magnolia State Bank

NEW ACCOUNT APPLICATION

Please complete the following application, print and submit to your local Magnolia State Bank office.

 

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

FOR OFFICE USE ONLY

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:

Special Memo :  msbbsms

The above signed acknowledge(s) receipt of a copy of and agree(s) to the terms of the following disclosure(s):
Truth in Savings     Electronic Funds     Transfer Funds Availability     Privacy