Deposit Account Application

Applicant

First Name
Middle Initial
Last Name
Social Security #
Primary Phone
Work Phone
Cell Phone
Email Address
Date of Birth
Best Time to Contact
Method of Contact
Address Line 1
Address Line 2
City
State
Zip
County
Other
Select if mailing address is different My mailing address is different than my address line 1

Present Employer
Occupation
Time at current employer
Years Employed in this Profession

Type of Deposit Account

Please check all of the applicable accounts you would like to open. If you don't currently know what account you would like to open just leave this section blank and a bank representative can discuss with you the available options.

select checking or savings Checking Savings Money Market Special

Branch Location

Please select which Raccoon Valley Bank branch you would like to sign your documents in.

By clicking Submit I certify that everything I have stated in this Application is correct to the best of my knowledge. I understand that you will retain this Application whether or not it is approved. You are authorized to check my credit and employment history and answer questions about your credit experience with me.

Deposit Account Application

Applicant

Type of Deposit Account

Checking

Savings

Branch Location