New Account Application

Important Information About Procedures for Opening a New Account:

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

Commercial account request will need to Contact National Bank & Trust by calling 979-968-4506

*Indicates Required Information

Applying for account as:* INDIVIDUAL   JOINT

  PRIMARY OWNER JOINT OWNER
First Name*
Middle Initial*
Last Name*
D.O.B.* (MM/DD/YY) (MM/DD/YY)
SSN*
P.O. Box
Street Address
City*
State*
ZIP*
Drivers License or State Issue ID*
Driver's License State*
Expiration Date of DL or State Issue ID*
Employer*
Daytime Phone Phone* (000-000-0000) (000-000-0000)
Evening Phone* (000-000-0000) (000-000-0000)

OWNERSHIP OF ACCOUNT

Personal Accounts

Single with POD Single without POD Multiple with ROS
       
Multiple without ROS Multiple with ROS & POD
 
List Beneficiaries

ACCOUNT INFORMATION

Initial Deposit
Previous Bank
Check Options
Wallet Style Checks Duplicate Style Checks

CHECK ONE OR MORE OF THE ACCOUNTS BELOW TO APPLY FOR:

NBT Free NBT Checking NBT Now NBT Star Checking
NBT Senior 65+ NBT Student NBT Regular Checking NBT Money Market
Certificate of Deposit IRAs NBT Savings    

CHECK ONE OR MORE OF THE SERVICES BELOW TO APPLY FOR:

Master Card Debit Card Safe Deposit Box Overdraft Protection Internet Banking

If you chose Debit Card please choose your 4 digit P.I.D.

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:

  I have been notified that I am subject to backup withholding.

  I am not a U.S. citizen or resident (complete W-8) form.

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 979-968-4506, or by e-mail at newaccts@nbt-texas.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.