FNCB Deposit Accounts Application

Primary Account Owner

Select Type of Ownership: *

Single Owner(individual) Joint (right to survorship)

Full Name (Last, First, MI) *

Enter your last name followed by your first and then your middle initial.

Social Security Number *

*NO dashes, slashes or spaces

Please enter your social security number with no dashes, slashes or spaces

Address: *

Enter your full address.

City and State: *

Enter your city and state.

Zip Code Plus 4 *

Home Phone Number:

Work Phone Number:

Please enter your daytime phone number including the area code

Driver's License Number & State:

Please enter your driver's license number and the state it is issued in.

Issue Date:

Please enter the date your driver's license was issued.

Expiration Date:

Please enter the expiration date of your driver's license.

Employer:

Please enter your Employer

Occupation:

If other, please enter your occupation:

Please enter your occupation

E-mail Address:

Please enter your email address

Mother's Maiden Name:

Please enter your Mother's Maiden Name

Select your citizenship status:

U.S. Citizen Non-Resident Alien
Resident Alien Permanent Resident

1 2 3 4

Joint Account Owner (if you selected joint account ownership)

Full Name (Last, First, MI)

Enter your last name followed by your first and then your middle initial.

Relationship:

What is your relationship to the Primary Account Holder

Date of Birth (mm/dd/yy):

Please enter your date of birth like so: 12/12/12

Social Security Number

*NO dashes, slashes or spaces

Please enter your social security number with no dashes, slashes or spaces

Address:

Please enter your address

City and State:

Please enter your city and your state.

Zip Code Plus 4

Please enter your zip code followed by plus 4 if you know it

Home Phone Number:

Please enter your home phone number including the area code

Work Phone Number:

Please enter your daytime phone number including the area code

Driver's License Number & State:

Please enter your driver's license number and the state it is issued in.

Issue Date:

Please enter the date your driver's license was issued like so: 12/12/12.

Expiration Date:

Please enter the expiration date of your driver's license like so: 12/12/12.

Employer:

Please enter your Employer

Occupation:

If other, please enter your occupation:

Please enter your occupation

E-mail Address:

Please enter your email address

Mother's Maiden Name:

Please enter your Mother's Maiden Name

Select your citizenship status:

U.S. Citizen Non-Resident Alien
Resident Alien Permanent Resident

1 2 3 4

Please provide the name(s) of any person on this account who is either a Foreign, Federal, State or Local official:

Name

Please enter the name of the person.

Title/Position:

Please enter their title and/or position.

Country/Municipality (if Foreign or Local)

Please enter their country or municipality.

Deposit Information

Initial Deposit($)

Please enter the initial amount you wish to deposit.

Select Initial Deposit Type:

Check Transfer from existing FNCB account

FNCB Account Number for Transfer (if selected)

Please enter the FNCB Account number if you've selected transfer

What is the intended purpose of the account?

Please enter the intended purpose for this account.

Future deposits to this account will come from what sources?

Please enter from what sources future deposits will come from for this account.

Are any authorized signers or owners an employee of FNCB or related to an employee, officer or director of FNCB?

Yes No

List all FNCB business customers you are associated with:

Please enter the intended purpose for this account.

What is the dollar amount of cash transactions anticipated per month?

What is the dollar amount of check deposit activity anticipated per month?

Will there be any wire transfer activity associated with this account?

Yes No

What is the dollar amount of Wire deposit activity anticipated per month? (e.g. direct deposit of payroll, social security, or pensions)

Please review your application responses for accuracy prior to submitting this application.

By clicking the Submit button below, I certify that I have read and agree to all the terms, authorizations, and disclosures for this account.

1 2 3 4

Related Links

FNCB Deposit Accounts Application Application

Disclosures:

Select the Type of Account you are applying for

Checking

Savings

Other

Primary Account Owner

Joint Account Owner (if you selected joint account ownership)

Deposit Information