Complete the following application. In order to complete the application process, please bring the completed application to one of our banking offices. For more information, please call (606) 474-7811.
IMPORTANT APPLICANT INFORMATION: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances, we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.
CHECKING ACCOUNT APPLICATION
Ownership Type: 

Single
Joint (with survivorship)
Joint (without survivorship)
UGMA/UTMA
Totten/Trust (ITF)
Payable on Death (POD)
 
Select all that apply:

I am interested in purchasing checks for my account.
I would like to apply for an ATM Card
I would like to apply for a VISA debit card.
I am interested in using Direct Deposit.
Primary Account Holder's Information
Last Name:
 First Name:
 Middle Initial:
Home Telephone Number:
 Social Security Number:
Street Address:
 City:
 State:
 Zip Code:
Mailing Address:
 City:
 State:
 Zip Code:
Employer (Company Name):
  
Employer Address:
 City:
 State:
 Zip Code:
Position / Title:
 Bus. Telephone Number:
 Cell Phone Number:
Birth Date:
 City of Birth:
 Mother's Maiden Name:
Drivers License #:
 State (of licensure):
Joint Account Holder's Information
Last Name:
 First Name:
 Middle Initial:
Home Telephone Number:
 Social Security Number:
Street Address:
 City:
 State:
 Zip Code:
Mailing Address:
 City:
 State:
 Zip Code:
Employer (Company Name):
  
Employer Address:
 City:
 State:
 Zip Code:
Position / Title:
 Bus. Telephone Number:
 Cell Phone Number:
Birth Date:
 City of Birth:
 Mother's Maiden Name:
Drivers License #:
 State (of licensure):
Additional Signers On Account
By adding names to the additional signers, you are allowing the person access to you account including signing checks, withdrawals, account inquiry, and any other account actions.
Signer # 1:
Signer # 2:
Signer # 3:
Signer # 4:
Signer # 5:
Signer # 6:
General Information
Thank you for your account application.  In order to complete the application process, please visit one of our banking locations.  For more information, please call (606) 474-7811.

Minimum initial deposit of $100.00 for Checking and/or $100.00 for Savings required.
Signatures

I certify that everything I have stated in this application and on any attachments is correct. Lender may keep this application whether or not it is approved. By signing below, I authorize Lender to check my credit and employment history and to answer questions others may ask Lender about my credit record with Lender. I understand that I must update credit information at Lender's request if my financial condition changes.

Applicant Signature:________________________________________

Other Signature:___________________________________________
(where applicable)