Premier Business Checking Application Republic Bank of Arizona

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Business Information

Business Name*

Business Type*

Contact Name*

Contact Date of Birth*

You must be 18+ to submit this form.

Permanent Address (Not a P.O. Box)*

Street Address Address Line 2 City State ZIP Code

Use residential address for mailing address*

Yes

Business Phone*

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Business Cell Phone (Optional)

Tax ID Number*

E-mail*

Contact Information

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Phone

Mail

When is the best time to arrange an appointment? (Optional)

Morning

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Republic Bank of Arizona reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, you grant full permission to do so.

Federal law requires all financial institutions to obtain and verify your name, address, date of birth and other information to help identify each person or entity that opens or applies for an account.

This field is for validation purposes and should be left unchanged.

Please fill out the fields in the form to the right. One of our representatives will contact you within one business day to complete the process.

This form supports the maximum level of encryption technology your browser allows, up to 256-bit SSL encryption to protect your personal information while it is in transit. Children under 13 should not send any information about themselves to the Bank, including information like your name, address, or email address. Please view our Privacy Policies for more information.

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