Request Information for
Personal Checking Account

HomeTown Bank is restricted, in most cases, to
serving our home and contiguous counties.

(Preliminary: You will be contacted by the bank.)
Member FDIC
 
Name:
Date:
Address:
City: State: ZIP:
Telephone: Fax:
Email:
Amount of
initial deposit:		 $
Account Type:
Checking Account:
Interest-Bearing Account:
HomeTown Club Account:
Contact me at:

Type any questions you have here, and we will gladly respond with the answers: