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Account Holder Disclosure Agreement

By pressing the Proceed button I acknowledge that upon verification of my personal identification I will be issued a Checking Account and Debit Card by Bridge Community Bank, pursuant to a license with Visa USA. I certify under penalty of perjury the accuracy of the information provided in this application, that I am not subject to backup withholding, that I am a U.S. person (including a U.S. resident alien), and I agree to be subject to the terms and conditions of the Cardholder Disclosure Agreement.

In order to comply with banking regulations, the information you have entered will be sent to a 3rd party screening company for validation. Please carefully check what you have entered and make any necessary corrections. Please verify that your birth date and social security number are correct, and note that we cannot accept PO Box addresses.