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Purpose of Funds:    
Are you a U.S. citizen?    
If no, are you a permanent resident?    


I understand and agree that by submitting this inquiry, neither I nor Applied Bank is committing to open an account, extend credit or render any service. This inquiry is submitted for the sole purpose of an Applied Bank Representative contacting me in order to further discuss this product with Applied Bank. If you have any questions about this product or Applied Bank, please call us at 302-326-4200 (x32052) or 302-326-4200 (x29082).