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New Account Application

Will there be a co-applicant on this account?

Primary Account Owner

Business Name
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Joint Account Owner (if applicable)

First Name
Last Name
Social Security Number
Date of Birth
Address
City, State, Zip
Phone Number
E-Mail Address We'll never share your email with anyone else.
Driver's License
Employer's Name
Employer's Phone

Account Information

Initial Deposit $
Previous Bank

Check one or more accounts to apply for:

Personal Account Business Account

Certification

I certify that I am at least 18 years of age and I have accurately and fully completed all items on this application. Under penalties of perjury, I certify that:

  1. The social security number (SSN) and/or tax payer identification number (TIN) shown above is my correct number;
  2. I am NOT subject to backup withholding because (a) I am exempt from backup witholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the Internal Revenue Service has notified me that I am no longer subject to backup withholding; and
  3. I am a U.S. person (including a U.S. resident alien). 

Or check all that apply:

The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

Please note, this application is subject to verification and approval. In order for us to process your application correctly, we may need to contact you to verify some of the information or request additional documentation. When you submit this application, you certify that everything stated above is true and accurate.  When you submit this application, you also agree that this Institution reserves the right to review your credit history through an authorized bureau.

If you have any questions, please contact us at (503) 668-5501, or by e-mail at ccbank@clackamascountybank.com.

By clicking below, I hereby certify that everything I have stated above is correct. You may keep this application whether or not it is approved. By clicking below, I authorize you to check my credit and employment history and verify other information which I have provided to you.

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