Membership Application

Institutional Member

To be eligible for institutional membership, a bank must be 51% minority-owned or have a majority-minority board and serve a predominantly minority community. The ethnic composition of eligible membership includes African-Americans, Asian-Americans, Native-Americans, Hispanic-Americans, and women-owned banks. Majority banks can join as strategic partners.

Annual dues will be based on bank assets and size.

Bank Name

Address

Apartment, suite, etc

City

Zip Code

Chairman's Name

President's Name

CEO's Name

Total Assets (in $ millions)

as of (date)

Total Deposits (in $ millions)

as of (date)

Minority Classification

Date Minority Classification Established

Date Bank Established

Number of Branches

Regulatory Agency

Charter Number

The following individuals are designated as the contact person(s) for the above-named bank.

Primary Contact

Full Name

Title

Address

Apartment, suite, etc

City

Zip Code

Email Address

Secondary Contact

Full Name

Title

Address

Apartment, suite, etc

City

Zip Code

Email Address

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Membership Application

Institutional Member

The following individuals are designated as the contact person(s) for the above-named bank.

Primary Contact

Secondary Contact

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