Apply Now Form Information First United Bank and Trust Company

Please fill out the fields in the form to the right. One of our representatives will contact you within one business day to complete the process.

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Personal Information

Are you a new customer?*

Yes, I am a new customer.
No, I am not a new customer.

Name*

First Last

Social Security Number*

Date of Birth*

Home Phone*

Daytime Phone*

Mother's Maiden Name*

Email*

Contact Information

Choose the location you would like to complete your application*

How would you prefer to be contacted?*

Phone
Mail
Email

When is the best time to arrange an appointment?*

Morning
Lunchtime
Afternoon

Address Information

Address*

Residential Address (Not a P.O. Box)

Street Address City State ZIP Code

Use residential address for mailing address*

Yes, use my residential address as my mailing address.
No, do not use my residential address as my mailing address.

Joint Account Information

Number of Joint Owners on this Account*

0
1
2

Joint Applicant #1

Joint Applicant #1 Relationship to Primary Applicant*

Joint Applicant #1 Name*

First Last

Joint Applicant #1 Date of Birth*

Joint Applicant #1 Social Security Number*

Joint Applicant #1 Drivers License Number*

Joint Applicant #1 State Licensed Issued*

Joint Applicant #1 Home Phone*

Joint Applicant #1 Work Phone*

Joint Applicant #1 Address*

Street Address City State ZIP Code

Joint Applicant #2

Joint Applicant #2 Relationship to Primary Applicant*

Joint Applicant #2 Name*

First Last

Joint Applicant #2 Date of Birth*

Joint Applicant #2 Social Security Number*

Joint Applicant #2 Drivers License Number*

Joint Applicant #2 State Licensed Issued*

Joint Applicant #2 Home Phone*

Joint Applicant #2 Work Phone*

Joint Applicant #2 Address*

Street Address City State ZIP Code

Comments

Consent

I agree to the following statement.

First United Bank and Trust Company reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, you grant full permission to do so.

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