open_account_online


	Account Type Please select one:


	Choose an account:


	Amount account will be opened with: (must be at least the minimum listed above)




	Source of Deposit:


	Please transfer from my current United Bank account


	I will transfer funds from another financial institution


	I will mail in a check or money order


	I will send a wire transfer


	Other: Please Explain:


	Personal Information




	* Required Fields


	Name:


	*


	Name of joint owner if any:


	Is this a corporation?


	Yes


	No


	If so, name of principal


	Home Address:

	City:


	*

		*


	State:

		Zip:


		*

	*


	Driver’s license:


	*


	Exp Date:


	*


	State of Issue:


	*


	E-mail:


	Home phone number:


	*


	Work phone number:


	Social Security number:


	*


	Taxpayer ID number (if different from SS number):


	Date of birth (mm/dd/yyy):


	*


	Mother’s maiden name for account verification:


	Other instructions or needs you may have:


	Joint Account Information


	Name of joint account owner: