First Name:

Middle Init:

Last Name:

SSN:

Alien ID #:

Physical Address:

Mailing Address:

City:

State:

  Zip: 

Drivers Lic. #:

  State:  AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VE VA WA WV WI WY

Date of Birth:

  Mother's Maiden Name: 

E-Mail:

Daytime Phone:

( )   Evening Phone:  ( )

Employer Name:

Employer Address:

City:

State:

  Zip: 

Employer Phone #:

  Household Income  (Optional): 

Yes, I would like to apply for a VISA check card (that also functions as an ATM card) for this checking account.

I UNDERSTAND THAT THIS IS AN APPLICATION FOR AN ACCOUNT WITH FIRST NATIONAL BANK OF THE ROCKIES.  SUCH APPROVAL WILL INCLUDE AN INQUIRY INTO MY CREDIT HISTORY THROUGH ONE OF THE MAJOR CREDIT BUREAUS AND PAST BANKING RELATIONSHIPS.

First Name:

Middle Init:

Last Name:

SSN:

Physical Address:

Mailing Address:

City:

State:

  Zip: 

Drivers Lic. #:

  State:  AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VE VA WA WV WI WY

Date of Birth:

Daytime Phone:

Yes, I would like to apply for a VISA check card (that also functions as an ATM card) for only the joint owner.

I UNDERSTAND THAT THIS IS AN APPLICATION FOR AN ACCOUNT WITH FIRST NATIONAL BANK OF THE ROCKIES.  SUCH APPROVAL WILL INCLUDE AN INQUIRY INTO MY CREDIT HISTORY THROUGH ONE OF THE MAJOR CREDIT BUREAUS AND PAST BANKING RELATIONSHIPS.

Initial Deposit:

Deposit Type:

VISA Mastercard Money Order Cashiers Check Personal Check Wire Transfer  

Wiring Instructions:

First National Bank of the Rockies
ABA # 1021 01 548
Credit (Your Name)
ATT:  New Accounts

If your initial deposit is made with a VISA/Mastercard, please complete the following fields.  Your account will not be charged until your application has been approved.

Card Number:

Expiration Date:

Certificate Amount:

Deposit Type:

VISA Mastercard Money Order Cashiers Check Personal Check Wire Transfer Checking Account Savings Account  

Wiring Instructions:

First National Bank of the Rockies
ABA # 1021 01 548
Credit (Your Name)
ATT:  New Accounts

If your certificate amount is made from savings, checking or multiple accounts, please complete the following fields.

Account Number:

Amount:

Account Number:

Amount:

If your certificate amount is made with a VISA/Mastercard, please complete the following fields.  Your account will not be charged until your application has been approved.

Card Number:

Expiration Date:

Taxpayer ID:

Leave blank if same as your SSN.

Taxpayer ID Number - The Taxpayer Identification Number shown above is my correct identification number.

Backup Withholding - I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding.

Exempt Recipients - I am an exempt recipient under the Internal Revenue Service Regulations.

Nonresident Aliens - I am NOT a United States person, or if I am an individual, I am neither a citizen nor a resident of the United States.

Alien ID Number:

Account Ownership Designation:

Individual Joint - With Survivorship Joint - No Survivorship Pay on Death Account  

Primary Beneficiary Name:

Relationship:

Deposit Account Type:

Elite Check Image Mature Market Check Image Free Checking Investors Choice First Choice Savings Young Savers 30 day Certificate of Deposit 60 day Certificate of Deposit 90 day Certificate of Deposit 6 month Certificate of Deposit 1 year Certificate of Deposit 1 1/2 year Certificate of Deposit 2 year Certificate of Deposit 3 year Certificate of Deposit 4 year Certificate of Deposit 5 year Certificate of Deposit 30 day IRA 60 day IRA 90 day IRA 6 month IRA 1 year IRA 1 1/2 year IRA 2 year IRA 3 year IRA 4 year IRA 5 year IRA  

For Certificates of Deposits and IRA's your account disclosures will be mailed to you, along with a receipt for your certificate.

By signing below, I agree to the Terms and Conditions of First National Bank of the Rockies Deposit Account Agreement and Disclosures below. 

The following represent the various disclosures for the accounts you are applying for.  It is important that you review these.  By clicking on the documents listed below a new windows will appear so you may view and print the Disclosures for your records.

Truth in Savings Disclosure
(Rate and Fee Schedule) Account Type:

Links to Disclosure Statements Elite Check Image Mature Market Check Image Free Checking Investors Choice First Choice Savings Young Savers  

Please print this application, sign it and send it to:

First National Bank of the Rockies
ATTN:  New Accounts
P.O. Box 600
Meeker, CO 81641