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To begin, please fill out the fields in the form below. One of our Bank Representatives will contact you within two business days.

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IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW VALLEY BANK 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. For existing customers we may request identifying documents and additional information to update our records.

What you will need to apply for an account:

Social Security Number
Birth Date
Street Address
2 types of ID
1st type: Virginia State Driver’s License OR Passport OR Military/Government Identification
2nd type: Social Security Card OR Student Identification Card OR Voter Registration Card OR Birth Certificate
Current Bank account number or source of initial deposit

* requires completion
I would like to open My Lifestyle Checking
Are you a new customer?   Yes No
Are you a US citizen?*   Yes No
Name
* *
* Last Name

*Tax ID Number (Social Security Number or TIN)

*Month of Birth

*Day of Birth

*Year of Birth
Street Address (No P.O. Boxes)

*Street Number

*Street Name

*City

*Zip
Mailing Address (If different from above)

Street Number

Street Name

City

Zip
Phone Numbers
) -
*Home Phone Number
) -
Business Phone Number
) -
Cell Phone Number
Identification Type 1
*Type of ID:
If Driver's License:

Driver's License Number
   

What State?

Issue Date

Expiration Date
Identification Type 2
*Type of ID:

Who Issued this ID?

Issue Date:

Expiration Date
Additional Information

*Mother's Maiden Name

*Personal Email Address

Business Email Address

Employer
Employer Address

Street Number

Street Name

City

State

Zip

*Profession
   
*Ownership of Account

(default to Withholding certification if only an individual)
* These will require information on the joint account holders.
Joint Account Holder Information (if applicable)
*
- -
*Social Security Number

*Date of Birth (MM/DD/YYYY)

*Month of Birth

*Day of Birth

*Year of Birth
Street Address (No P.O. Boxes)

*Street Number

*Street Name

*City

*Zip
Mailing Address (If different from above)

Street Number

Street Name

City

Zip
Phone Numbers
) -
*Home Phone Number
) -
Business Phone Number
) -
Cell Phone Number
Identification Type 1
*Type of ID:
If Driver's License:

Driver's License Number
   

What State?

Issue Date:

Expiration Date
Identification Type 2
*Type of ID:

Who Issued this ID?

Issue Date:

Expiration Date
Additional Information

*Mother's Maiden Name

*Personal Email Address

Business Email Address

Employer
Pay On Death

Beneficiary Name(s)

Beneficiary Name(s)

Address

Social Security Number 1

Social Security Number 2
Backup Withholding Certifications - Customers will mark those that apply
Taxpayer ID Number – Number shown above is my correct taxpayer identification number.
Backup Withholding – I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding.
Exempt Recipients – I am an exempt recipient under the Internal Revenue Service Regulations.
I am also interested in these Valley Bank products:
Online Banking
eStatements
Bill Pay
Check Card
 
By submitting this application, you agree that everything you have stated is correct to the best of your knowledge and if there is a co applicant that you are authorized to submit on their behalf also. This application is subject to additional verifications and you authorize Valley Bank to make any inquiries including verification of employment and obtaining credit reports with credit reporting agencies and other account information services in order to open your account.
  


Thank you for your interest in electronic account opening disclosures from Valley Bank. As part of the registration process, please read the following Consent and Authorization disclosure and indicate your acceptance at the bottom.


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