Product Inquiry Form - Personal

We understand that your time is valuable! This form is intended to notify bank personnel of your interest in our products.

For most products, the submission of this online form will not replace the necessity for you to personally visit one of our convenient locations to complete the enrollment process. This will likely include:

  • Obtaining any additional information needed
  • Obtaining your signature on necessary account agreements/documents
  • Verification of identification
  • Receipt of appropriate regulatory disclosures, etc.

After submitting this online form you will be contacted by a representative from the bank via e-mail or phone within two business days to schedule an appointment for completion of the emrollment process. Should you have any questions, do not hesitate to contact us.

* Indicates a required field.

 

Are you a current Bank of Charles Town Customer?*  
What Product(s) Are You Interested In? Individual/Joint
Individual
Individual
Individual
Customer General Information
*
*
*
*
: ,
*
(000-000-0000)
*
(000-000-0000)
*
(mm/dd/yyyy)
*
(000-00-0000)
*
State of Driver's License: *
*
(youraddress@yourhost.com)
*
Joint Customer General Information
*
*
*
*
State & Zip:* ,
Home Phone:*
(000-000-0000)
Daytime Phone:*
(000-000-0000)
Date of Birth: *
(mm/dd/yyyy)
Social Security Number: *
(000-00-0000)
Driver's License Number: *
State of Driver's License: *
Email Address: *
(youraddress@yourhost.com)
*
Online Banking Information
- OR -
Account Number Descriptive Name
Bill Pay Information

* 

Certificate of Deposit (CD)

* 

* 

Individual Retirement Account (IRA)

* 

* 

Customer Residence Information
 
*
*
Customer Employment Information
*
*
*
*
*
: ,
Business Phone:*
(000-000-0000)

(if less than 3 years)
Customer Income & Asset Information

(Alimony or child support or separate maintenance payments are optional information & need not be revealed if the applicant does not choose to rely on such income in applying for credit.)













Joint Customer Residence Information
 
*
*
Joint Customer Employment Information
*
*
*
*
*
: ,
Business Phone:*
(000-000-0000)

(if less than 3 years)
Joint Customer Income & Asset Information

(Alimony or child support or separate maintenance payments are optional information & need not be revealed if the applicant does not choose to rely on such income in applying for credit.)













Consumer Loan Information

* 

* 

* 

Mortgage Loan Information

* 

* 

* 

Application Completion Information
Choose the location you would like to complete your application:
How would you prefer to be contacted?
When is the best time to arrange an appointment?