Download to download. - NebraskaLand National Bank

NebraskaLand National Bank Welcomes You
Please complete the following items:
Legal Name (First, Middle Initial, Last): ____________________________________________
Date of Birth (Month, Date, Year): ___________________
Residency Status (circle one): U.S. Citizen
Resident Alien Non-Resident Alien
Social Security Number: ____________________
Physical Address (P.O. Box Not accepted):
________________________________________
________________________________________
Mailing Address (if different):
________________________________________
________________________________________
Occupation: ____________________________________________________________________
*If retired please indicate your previous occupation.
Employer: ______________________________________________________________________
Home Phone (Required): (______)____________________
Cellular Phone (Optional): (______)___________________
Business Phone (Optional): (______)___________________
Email:
_________________________________
PIN # (if requesting a Debit Card):____________
Mother’s Maiden Name (if you would like online banking):_____
______________
We need to collect TWO copies of Identification, one copy from the box on the left and one copy from the box on
the right. Please attach a copy of each.
Primary ID’s: (provide one copy and attach)
U.S. Citizen’s:
U.S State Issued Driver’s License
U.S. State Issued Identification
U.S. Military Identification
U.S. Issued Passport
Resident Alien:
Green Card/Permanent Resident Card
Non-Resident Alien:
U.S. Visa (Non-Resident Alien Only)
U.S. Employment Authorization Card
Foreign Passport
Secondary ID’s: (provide one copy and attach)
Social Security Card
W-2
Credit Card/Debit Card
Tribal ID Card
Insurance Card
Income Tax Return
Birth Certificate
Local Utility Bill
Firearm License
Property Tax Bill
Voter Registration Card
Student ID Card
Local Employer ID Card
Concealed Handgun Permit