Apply for an account:

Applicant:
Social Security Number:
Date of Birth:

 

E-mail Address:
Street Address :
City:
State:
Zip Code:
Time at Address:
Home Phone:

 

Mother's Maiden Name:
City of Birth:
Form of ID :
ID Number:
Issue Date:
Expiration Date :
Identification State :

 

Note:
This section is not required if you have lived at your current address for more than 2 years.

Previous Street Address :
City:
State :
Zip Code:

 

What is your current employment status?.

Employment Status:

 

Do you rent or own or other?:


Landlord or Mortgage Name:
Monthly Payment :
Other Income:

Source of Other Income:

* Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis of creditworthiness.

 

Best way to contact you:

       

 

How would you like to fund your account?.

Opening Deposit:


Routing Number:
 

 

I would like to apply for an SCSB debit card:      
Other Comments :

 

Agreement

I (We) certify the above information to be true in every respect and that it correctly reflects my (our) current financial position. I agree to provide a written financial statement upon request. I authorize the creditor to make whatever credit inquiries it deems necessary in conjunction with my credit application or in the course of review or collection of any credit extended in reliance on the application, including without limitation, inquiries to any government – federal, state or local. I authorize and instruct any person, government agency, or consumer protection agency to compile and furnish the creditor any information it may have or obtain in response to such credit inquiries and agree the same shall remain the property of the creditor whether or not credit is extended. If a security interest in real estate will be taken, I understand the bank may contact me to obtain the full names of all individuals having a legal ownership in the property and complete legal description of the real estate.

I accept and agree to the terms of the retail deposit agreement and disclosures that have been or will be provided in connection with account(s) being applied for.