To receive more information on BUSINESS ACCOUNT PRODUCTS, simply complete and submit this information request form. Bank of Doniphan will contact you and/or send you more information regarding the requested products. Submitting this form is NOT an application for an account.

A representative from Bank of Doniphan may contact you to verify your requests. Feel free to contact us with any questions you may have.

For information regarding Personal account products, please click here.

* = Required Field

All applicants must complete Section A.
If you are applying for a business deposit account, complete Sections A and B.
If you are applying for a business loan, complete Sections A and C.
If you are applying for both deposit and loan accounts, complete all three sections.
If you work in Nebraska and reside outside of Nebraska please contact us.
I am applying for:
(check all that apply)
DEPOSIT ACCOUNTS
Checking
Savings
CDs
Retirement
Merchant Processing
Credit Cards
Ag Products
LOANS
Operating Line of Credit
Term Loans
Construction Loans
Real Estate Loans
SECTION A - General Information
Business Name:*
Business Type:*
Business Address:*
City:*
State:
Nebraska
Zip Code:*
Mailing Address
(if applicable)
City:
State:
NE
Zip Code :
Business Phone:*
(please include area code)
Email Address:
Fax:
Tax ID Number:
Date of Birth:*
Authorized Signer Name:*
2nd Authorized Signer Name:
(if applicable)
3rd Authorized Signer Name:
(if applicable)
Primary Contact:
Title:
SECTION B - Deposit Account Information
Amount of Initial Deposit:
How Initial Deposit
Will Be Made:
I will mail a check to Bank of Doniphan
Incoming Wire
Debit my existing 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 :
Drivers License of Primary Contact:*
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 DONIPHAN 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 DONIPHAN.
I HAVE READ THE ABOVE STATEMENT AND AGREE TO THE TERMS SET OUT THEREIN.
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