KARNES COUNTY NATIONAL BANK
NEW ACCOUNT CUSTOMER APPLICATION
CHECKING
DATE:________________
SAVINGS
CD
ACCT.#_________________
DEPOST AMOUNT___________________
IRA
NEW_________
SDB
REOPENED________
CASH/CK_________________
(PRIMARY)
U.S. CITIZEN__________
NAME__________________________________________ SOC SEC#_______________ CERT_______
(PRINT)
FIRST
MIDDLE
LAST
DL/ID#________________ STATE______
HM#__________________________
CELL#____________________ DOB________________
OTHER IDENTIFICATION:________________________________________________________________
PREVIOUS/CURRENT BANK______________________________________________________________
OCCUPATION_____________________________
WK#_______________________________
EMPLOYER NAME/ADDRESS_____________________________________________________________
(SECONDARY)
U.S. CITIZEN__________
NAME__________________________________________ SOC SEC#_______________ CERT_______
(PRINT)
FIRST
MIDDLE
LAST
DL/ID#________________ STATE______
HM#_________________________
CELL#____________________ DOB________________
OTHER IDENTIFICATION:________________________________________________________________
PREVIOUS/CURRENT BANK______________________________________________________________
OCCUPATION_____________________________
WK#_______________________________
EMPLOYER NAME/ADDRESS_____________________________________________________________
ADDRESS:
________________________________________
________________________________________
PREVIOUS ADRESS:
(IF AT CURRENT LESS THAN 2 YRS)
___________________________________
___________________________________
STATEMENTS TO BE MAILED TO: (IF DIFFERENT FROM ABOVE)
________________________________________
DEBIT CARD_________________________
________________________________________
CHECKS_____________________________
NAME OR NAMES OF BENEFICIARIES: (NEED A COPY OF THEIR SOCIAL SECURITY CARD)
____________________________________________________________________________________
____________________________________________________________________________________
SAFE DEPOSIT BOX BILLING INFORMATION - CHARGE TO CHECKING OR SAVINGS OR MAIL TO THE
ADDRESS BELOW:
____________________________________________________________________________________
I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND COMPLETE
________________________________________
___________________________________
PRIMARY APPL SIGNATURE
JOINT APPL SIGNATURE
DATE
DATE