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Deposit Account Application

DEPOSIT ACCOUNT APPLICATION

Please provide some basic information to help get the process started. Your information will be sent securely to a Green Belt Bank & Trust local expert.

Leave me blank for Deposit Account Application.

New Account Application Personal Accounts* Indicates Required Field

Please Select: *

Individual Account

Joint Account

Branch

Select the type of account you are interested in *

Select the type of checking account, if known

Select the type of savings account, if known

Applicant First Name *

Middle Name

Last Name *

Last 4 Digits of SSN *

Date of Birth *
MM/DD/YYYY

Street Address *

City *

State *

Zip *

Mailing address is same as street address

Mailing Address *

Mailing address City *

Mailing address State *

Mailing address Zip *

Cell Phone *

Home Phone

Email *

Employer *

Occupation/Job Title *

Are you a U.S. citizen?

Yes (I am a U.S. citizen)

No (I am not a U.S. citizen)

What is your home country?

Driver's License Number

State Issued

Issued Date

Expiration Date

Joint Applicant Information

Joint Applicant First Name *

Joint Applicant Middle Name

Joint Applicant Last Name *

Joint Applicant Last 4 Digits of SSN *

Joint Applicant Date of Birth * MM/DD/YYYY

Joint Applicant Street Address *

Joint Applicant City *

Joint Applicant State *

Joint Applicant Zip *

Joint Applicant Mailing address is same as street address

Joint Applicant Mailing Address *

Joint Applicant mailing address City *

Joint applicant mailing address State *

Joint applicant mailing address Zip *

Joint Applicant Cell Phone *

Joint Applicant Home Phone

Joint Applicant Email *

Joint Applicant Employer *

Joint Applicant Occupation/Job Title *

Are you a U.S. citizen?

Yes (I (joint applicant) am a U.S. citizen)

No (I (joint applicant) am not a U.S. citizen)

Joint Applicant, What is your home country?

Joint Applicant Driver's License Number

Joint Applicant State Issued

Joint Applicant Issued Date

Joint Applicant Expiration Date

Make up of first deposit

Cash

Other Other item description

Reason(s) for choosing GBBT:

How did you hear about Green Belt Bank & Trust?

Newspaper

Radio

Direct Mail

Signage

Relative/Friend

Phone Book

Web

Employee

Name Name of employee

What bank services do you anticipate using?

Estimate # and $ amount of anticipated transactions per month.

Services

Number (#)

Amount ($)

Currency Deposits

Currency Deposits Number (#)

Currency Deposits Amount ($)

Currency Withdrawals

Currency Withdrawals Number (#)

Currency Withdrawals Amount ($)

ACH/Check Deposits

ACH/Check Deposits Number (#)

ACH/Check Deposits Amount ($)

ACH/Check Withdrawals

ACH/Check Withdrawals Number (#)

ACH/Check Withdrawals Amount ($)

ACH/Wire Service

ACH/Wire Service Number (#)

ACH/Wire Service Amount ($)

Internet Banking *

Yes (I would like internet banking)

No (I would not like internet banking)

Debit/ATM Card *

(Debit card not available for savings accounts)

Yes (I would like a debit card/ATM card)

No (I would no like a debit card/ATM card)

By submitting below, you agree that we may verify credit record by any means necessary, including preparation of a credit report by a consumer reporting agency. If signing on behalf of a business or or other entity, you also acknowledge that we may verify the creditworthiness of that entity.

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Contact Us

Iowa Falls 641-648-2544

Grundy Center 319-824-2600

Belmond 641-444-3956

Ackley 641-847-0011

Eldora 641-858-2005

Parkersburg 319-346-8144

Toll Free 800-648-2544

© Green Belt Bank & Trust

Equal Housing Lender

Member FDIC

Routing # 073921679

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