American National Bank New Personal Account Application



Date ______________________
Existing Customer

Name:_________________________________________SSN:______-____-________DOB:__________
Name:_________________________________________SSN:______-____-________DOB:__________
Name:_________________________________________SSN:______-____-________DOB:__________
Name:_________________________________________SSN:______-____-________DOB:__________
Physical Address:_______________________________City:______________State:_____ Zip:_________
Mailing Address:_______________________________ City:______________ State:_____ Zip:_________
Previous Address (if applicable)____________________________________________________________
Phone Number: ________________________ Business Phone Number:____________________________
Drivers License Number: ______________________Issue Date____________ Expiration Date__________
State of Issuance _____________________________

Employer:____________________________________Occupation______________________________
E-Mail _________________________________

Type of Account:
Checking:_________________________________Savings:_______________________________
Certificate of Deposit ________________________ IRA _________________________________
Safe Deposit Box ___________________________

Telephone Pin __________ VRT__________ ATM __________ VDC__________
Alternate Form of ID ___________________________________________________________________
Non-documentary methods to verify customer identity: Application taken by: ________

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.

Accepted:

________________________________________________
Applicant Date

________________________________________________
Applicant Date