Personal Account Application

To Apply, having already read and accepted account disclosures, simply complete and submit application. Bank of Bartlett, upon approval, will send to you a new account packet. After executing the enclosed documents as indicated, return to us to activate your account.

A representative from Bank of Bartlett may contact you to verify your account application. Feel free to contact us with any questions you may have.

* = Required Field

 


All applicants must complete Section A. If you are applying for a consumer deposit account, complete Sections A and B. If you are applying for a consumer loan, complete Sections A and C. If you are applying for both deposit and loan accounts, complete all three sections.

If you work in Tennessee and reside outside of Tennessee please contact us.

I am applying for:
(check all that apply)

DEPOSIT ACCOUNTS

Prime Advantage Checking
Prime Set Advantage Checking
Prime Set Checking
Prime Net Checking
Super Bonus (Super NOW)
Bonus (NOW)
Regular Checking
Free Checking
Regular Savings
Hi-Fi Money Market
Hi-Fi Money Market Plus
Certificate of Deposit
Individual Retirement Accounts (IRAs)
Debit Cards
ATM Cards

LOANS (must be 18 yrs. of age to apply.)

Signature Loan
Home Equity Line of Credit (HELOC)
Overdraft Privilege
Secured Installment Loan
Automobile Loan
Fixed Rate First Mortgage Loan
Second Mortgage Loan
Visa/MasterCard
Visa Platinum
Demand Deposit Loan

SECTION A - General Information
Last Name:*
 First Name:*
Middle Initial:*
Home Address :*
 City:*
 State:
TN 		Zip Code:*
Mailing Address (if applicable):
 City:
 State:
TN 		Zip Code:
Previous Home Address:
 City:

 State:

 Zip Code:
Home Phone (please include area code):*
 Email Address:

 Fax:
Date of Birth:*

 Social Security Number:*
Employer:*

 Employer Address:
City:
State:

 Zip Code:
Employer Telephone:
Years There:

Position / Title:
Previous Employer (if less than 2 years at current employment):

 Previous Employer Address:
City:
State:

 Zip Code:
Joint Applicant Information
*Note, you do not need to fill out this section unless you are applying for a joint application
Last Name:
 First Name:
 Middle Initial:
Home Address :
 City:
 State:
 Zip Code:
Previous Home Address:
 City:

 State:

 Zip Code:
Home Phone (please include area code):
 Email Address:

 Fax:
Date of Birth:

 Social Security Number:
Employer:

 Employer Address:
City:
State:

 Zip Code:
Employer Telephone:
Years There:

Position / Title:
Previous Employer (if less than 2 years at current employment):

 Previous Employer Address:
City:
State:

 Zip Code:
SECTION B - Deposit Account Information
CD Term:
(This is only if you choose a Certificate of Deposit)
CD Interest:
(This is only if you choose a Certificate of Deposit)
Amount of Initial Deposit:
How Initial Deposit Will Be Made: I will mail a check to Bank of Bartlett
Incoming Wire
Debit my existing Bank of Bartlett account
                       Account Number
Debit my current Bank (You will receive a form for authorization)
                       Bank Name
                       Account Number
                       ABA Number
Please Provide The Following Verification Information:
Name of Current Bank:
 Address of Bank:
 City:
State:
 Zip Code:
 Account Number :
TN Drivers License or State Iissue ID Number:*
 Are you a US Citizen?
Yes
No
NOTE: If you do not have a drivers license or state issued ID, please call one of our Customer Service Representatives at (901) 382-6600.
Nearest Relative Not Living With You:

 Address:
 City:
State:

 Zip Code:
 Phone Number (including area code):
Mother's Maiden Name (for security purposes):
The Following Services Are Subject To Credit Approval:
*Would you like to apply for an Bank of Bartlett VISA Check Card?:
Yes     No
If so, please pick four numbers for your secret code:
 Please reconfirm your secret code:
*Would you like to apply for overdraft protection?:
Yes     No
If yes, please complete Income Information in Section C of this application
SECTION C - Loan Application Information
Purpose of Loan:

If the credit line or loan is for home purchase, refinance, construction-to-perm, repair or maintenance, the following information is requested by the Federal government to monitor this lender's compliance with the Equal Credit Opportunity and Fair Housing Laws. The law provides that a lender may neither discriminate on the basis of this information nor on whether or not it is furnished. If you do not wish to furnish this information please indicate below.

If you are applying for a Home Equity Line of Credit Loan (HELOC), do not complete "Race / National Origin / or Sex" questions.

Applicant:     
I do not wish to furnish this information
Ethnicity:
Race or National Origin:
 
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White		 Sex:
Co-Applicant:     
I do not wish to furnish this information
Ethnicity:
Race or National Origin:
 
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White		 Sex:
Amount Requested:

Gross Annual Income:

Length of Repayment Requested:

(NOTE: Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation)
Do you own your home (or other real estate you would offer as collateral):
Yes   No
If yes, please provide the value of that real estate:
Amount of First Mortgage:
 Amount of Second Mortgage:
 
BY CLICKING ON THE SUBMIT BUTTON BELOW, I (WE) APPLY FOR THE LOAN AND/OR DEPOSIT PRODUCTS LISTED ABOVE AND CERTIFY THAT ALL INFORMATION PROVIDED ABOVE IS CORRECT AND AUTHORIZE YOU TO CHECK MY (OUR) CREDIT AND VERIFY THE INFORMATION PROVIDED IN THIS APPLICATION. I (WE) ALSO CERTIFY UNDER PENALTY OF PERJURY THAT THE SOCIAL SECURITY NUMBER(S) PROVIDED ABOVE IS/ARE CORRECT AND THAT I AM NOT (WE ARE NOT) SUBJECT TO BACKUP WITHHOLDING UNDER THE INTERNAL REVENUE CODE. I (WE) UNDERSTAND THAT ADDITIONAL INFORMATION MAY BE REQUIRED BEFORE A DECISION CAN BE MADE REGARDING THIS APPLICATION. I (WE) FURTHER UNDERSTAND THAT APPROVAL BY BANK OF BARTLETT FOR ANY OF THE LOAN OR DEPOSIT PRODUCTS IS CONDITIONED ON MY (OUR) AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS CONTAINED IN THE APPLICABLE LOAN AGREEMENT AND/OR DEPOSIT AGREEMENT. I FURTHER AGREE TO RETURN ANY ACCESS DEVICE FOR OBTAINING FUNDS FROM ANY TYPE OF ACCOUNT UPON DEMAND BY BANK OF BARTLETT.
 
I HAVE READ THE ABOVE STATEMENT AND AGREE TO THE TERMS SET OUT THEREIN.