Community Bankers of Washington Membership Application

Membership Information Update

Bank Name

Address 1

Address 2

City

State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico

Zip

Phone

Fax

Email

Mailing Address (if different)

Address 1

Address 2

City

State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico

Zip

Main Contact

First Name

Last Name

Address 1

Address 2

City

State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico

Zip

Title

Phone

Fax

Email

Chairman

First Name

Last Name

Email

President

First Name

Last Name

Email

Chief Credit Officer

First Name

Last Name

Email

Chief Financial Officer

First Name

Last Name

Email

Chief Operating Officer

First Name

Last Name

Email

Human Resources Officer

First Name

Last Name

Email

Training Officer

First Name

Last Name

Email

Additional Information

Total Assets as of December 31st Last Year

Total Deposits

Employees FTE

Number of Branches including main

Stock symbol

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