Date __________________________
Name of Entity or Individual________________________________________________________
DBA __________________________________________________________________________

Form of Organization
____Corporation ______Certified Articles of Incorporation  ____Limited Liability Company   ______Government Issued Business License
____Limited Partnership ______Partnership Agreement ____Joint Venture  ______Trust Instrument
General Partnership ______Other

Employer Identification Number ____________________________________________
Sole Proprietor_________________________
Social Security Number ________________________________________
(Sole proprietor or one person LLC only)

Mailing Address_____________________________________________________________
________________________________________________________________
Business Address________________________________________________________________
________________________________________________________________
Phone ____________________________________________________
Fax ___________________________________________
Website ________________________________________

Description of Business, i.e. Products, services _______________________________________
Clientele, geographic area, etc. _________________________
__________________________________________________________

Make-up of first deposit _________________________________
Type of Account _____________________ Acct. #_____________

Identification of Person Opening Account_________________________
___________________________________________________________

Please check the services you expect to use:
Deposits _______ Frequency _____________________
Cash Withdrawals _____ Frequency ________________
Wire Transfers _______ Outgoing to _____________________________
Incoming from ___________________________
Loans ___________________________________________
Safe Deposit Box ________________________________
Private Banking _________________________________

The undersigned hereby declare and represent that they have read the foregoing Application, that all statements made therein are complete and true to their knowledge. The applicant authorizes the Bank to verify the information contained herein and to make such additional normal inquiries as reasonably may be related to or associated with this Application, from credit bureaus and from employers, references with other financial institutions, and agree that such information, along with this Application, shall remain the bank's property.