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Business Deposit Account Application

Note:  Once your application has been received one of our Customer Service
Representative will be contacting you to schedule an appointment at the bank in order
to complete the account opening process.
*Indicates a Required Field
Account Desired: *

Business Applicant

Certification of Beneficial Owner(s) and controlling Person of Legal Entity (Certification)

Equity Owner 1

Owner 1 Are you a US Citizen?

Equity Owner 2

Owner 2 Are you a US Citizen?

Equity Owner 3

Owner 3 Are you a US Citizen?

Complete the following information for an individual with significant responsibility for managing the above listed business, i.e., Executive officer (CEO, CFO, and COO, Managing Member, General Partner, President, Vice President or Treasurer), OR any other individual who regularly performs similar functions.

Significant Individual Are you a US Citizen?

Authorized Signers

Authorized Signer 1

Authorized Signer 1 Are you a US Citizen?

Authorized Signer 2

Authorized Signer 2 Are you a US Citizen?

Authorized Signer 3

Authorized Signer 3 Are you a US Citizen?

Business Account Due Diligence

Source of Funds *
Do you/Will you cash checks for people? *
What type of checks are cashed?
Do you/Will you sell cashier's checks or money orders? *
Do you/Will you perform money wire transfers? *
Are you an agent for a money transfer service? *
Do you/Will you sell prepaid stored value cards? *
Do you/Will you perform currency exchanges? *
Internet Gambling *
I, the Person completing this form, hereby certify, to the best of my knowledge, that the information provided herein is complete and correct. I also agree to notify Citizens National Bank of any change in the information provided within this Certification.
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