Agricultural/Business Checking Application

*Must be at least 18 years of age to apply for a loan or deposit account alone

BUSINESS INFORMATION
Primary Business Officer's Name(Required)
Business Address(Required)
Date of Birth (if Sole Proprietorship)
Do you currently have a checking account?
Which of the following benefits are important to you?
Authorized Signers:
Name (Authorized Signer 1)(Required)
Date of Birth
Name (Authorized Signer 2)
Date of Birth
Disclosures & Acknowledgements

USA Patriot Act Disclosure

On September 11, 2001 our lives changed forever. In an effort to protect you and our country, the USA Patriot Act was signed into law. To help the government fight the funding or terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account.

You are applying for a deposit account. We therefore asked you for your name, address, date of birth and other information that will allow us to identify you. If you are not currently a Heritage Bank customer, we must also ask you to complete the driver’s license or other identifying information below.


Certification & Authorization

I/we understand that a bank employee will contact me to discuss product options and set up a time when I/we can come to the bank to finish opening the account (sign the account agreement and receive all of the necessary disclosures related to the product we choose). I/we understand that I/we will be the only individual(s) authorized to use this account. I/we authorize the bank to make inquiries to the credit bureau, and verify all information on this application. I/we acknowledge that all Heritage Bank locations are in fact part of one bank and that the deposits held at each office are not separately insured.

Certification & Authorization(Required)
This field is for validation purposes and should be left unchanged.