TO REPORT A LOST OR STOLEN VISA CHECK CARD AFTER NORMAL
BANKING HOURS, PLEASE
CALL
1-800-523-4175
The form can
only be processed with your signature.
Enter the information in the application, print, sign
and
return to any Glennville Bank location..
Will there be a co-applicant on this application?
Yes
No
Which type of acount would you like to open?
Checking Account
Savings Account
Certificate of Deposit
IRA
Primary Applicant
Last Name:
First Name:
SSN:
Date of Birth:
Address:
City:
State:
Home Phone:
Zip Code:
Email Address:
Employer's Name:
Employer's Phone:
Mother's Maiden Name:
Joint Applicant (if applicable)
Last Name:
First Name:
SSN:
Date of Birth:
Address:
City:
State:
Home Phone:
Zip Code:
Email Address:
Employer's Name:
Employer's Phone:
Mother's Maiden Name:
I certify that statements on this application
are true and complete. I authorize any person,
association, firm or corporation to furnish, on request
of Online Financial Institution, any
information concerning my affairs or me. Sec. 1014,
Title 13, U.S. Code, makes it a Federal
Crime to knowingly make a false statement on this
application.
Signature ______________________________ Date
________________
Glennville Bank
102 East Barnard Street
Glennville, Georgia 30427
(912) 654-3471 * Fax (912) 654-1517
Ludowici Bank
5 Cypress Street
Highway 84 East
Ludowici, Georgia 31316
(912) 545-2530 * Fax (912) 545-3334
