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Business Information

  • OK Business Name is required
  • OK Business Type is required
  • OK Contact Name is required
  • OK Permanent Address (Not a P.O. Box) is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • Use residential address for mailing address

    OK Use residential address for mailing address is required
  • OK Mailing Address (if different than above) is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • OK Business Phone is required
  • Optional OK Business Fax is required
  • Optional OK Business Cell Phone is required
  • OK Tax ID Number is required
  • OK E-mail is required

Contact Information

  • How would you prefer to be contacted?

    Optional OK How would you prefer to be contacted? is required
  • When is the best time to arrange an appointment?

    Optional OK When is the best time to arrange an appointment? is required

Comments

  • Optional OK is required

Security Code

  • OK is required
  • USA Patriot ACT
    Important Information About Opening
    A Legal Entity Account

    Section 326 of the USA Patriot Act requires all financial institutions to obtain, verify and record information that identifies each person who opens and account for a covered Legal Entity. New Rules under the Bank Secrecy Act will aid the government in the fight against crimes to evade financial measures designed to combat terrorism and other national security threats. Each time an account is opened for a covered Legal Entity, we are required to ask you for identifying information (name, address, date of birth, social security number and identification documents) for:

    • Each individual that has beneficial ownership (25% or more) in the Legal Entity; and
    • One individual that has significant managerial responsibly for the Legal Entity.

    We proudly support all efforts to protect and maintain the security of our customers and our country.


    Millbury National Bank 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.