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Checking Savings Application

Village Bank Checking/Savings Account Application
Please print this form, fill it out and fax to 763-753-6002
Account Information

Will there be a co-applicant on this application?
emptycheckbox
Yes
emptycheckbox
No

I am interested in:
emptycheckbox Checking Account
Type of Checking Account: ____________________________________________
Initial Deposit Amount: $_______________________________________________
Source of Deposit:

emptycheckbox Transfer from a current account. Account Number: _____________________

emptycheckbox I will transfer funds from another institution.

emptycheckbox I will mail a check/money order.

emptycheckbox Other. (please describe) _________________________________________

emptycheckbox Savings Account
Type of Savings Account: _____________________________________________
Initial Deposit Amount: $_______________________________________________
Source of Deposit:

emptycheckbox Transfer from a current account. Account Number: _____________________

emptycheckbox I will transfer funds from another institution.

emptycheckbox I will mail a check/money order.

emptycheckbox Other. (please describe) _________________________________________

emptycheckbox Other Account
Description: ________________________________________________________
Initial Deposit Amount: $_______________________________________________
Source of Deposit:

emptycheckbox Transfer from a current account. Account Number: _____________________

emptycheckbox I will transfer funds from another institution.

emptycheckbox I will mail a check/money order.

emptycheckbox Other. (please describe) _________________________________________

I am also interested in:
emptycheckbox ATM Card
emptycheckbox ATM and Check/Debit Card
emptycheckbox Credit Card
emptycheckbox Direct Deposit
emptycheckbox Other (please describe) ______________________________________________

Primary Applicant
Last Name: Account Number:
First Name: Middle Name:
Social Security Number (TIN): Date of Birth:
Home Phone Number: Work Phone Number:
Other Phone Number: Email Address:
Drivers License #: Drivers License State:
Mother’s Maiden Name: Present Employer Name:
Home Address
Address 1:
Address 2:
City: State, Zip:
Co-Applicant
Last Name: Account Number:
First Name: Middle Name:
Social Security Number (TIN): Date of Birth:
Home Phone Number: Work Phone Number:
Other Phone Number: Email Address:
Drivers License #: Drivers License State:
Mother’s Maiden Name: Present Employer Name:
Home Address
Address 1:
Address 2:
City: State, Zip:
Additional Information
How would you prefer to be contacted?
emptycheckbox Home Phone
emptycheckbox Work Phone
emptycheckbox Other Phone
emptycheckbox Email Address
emptycheckbox Other:
Special Instructions/Comments:

Signatures
Primary Applicant Signature: Date:
Co-Applicant Signature: Date: