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E-mail is not necessarily secure against interception. If your communication is very sensitive, or includes personal information such as your account numbers, credit card number or social security number, you may want to call us, or send it through the U.S. Post Office.

How would you like to use this form?

Check all that apply
General Comments
Goldwater Bank Request Product Information
Goldwater Bank Request CD Rate Quote
Goldwater Bank Loan Application Request

How would you like us to answer you?

Telephone Fax Regular Mail E-Mail

General Comments:

Request Product Information

Lending Products
Automobile Loan
Home Equity Loan
Home Equity Line of Credit
Home Improvement Loan
Mortgage Loan
Mortgage Refinancing
Small Business Loan

Deposit Products
Business Checking
Money Market Account
Personal Checking Accounts
Personal Savings Accounts

Investment Products
Certificates of Deposit

Other Products or Services

Request CD Rate Quote

Amount: CD Term: Months Years

Is your principal CD amount from your IRA?
No Yes

Your Comments (if any)

Loan Application Request

Amount Requested: Term: Months Years

Purpose of Loan:
Are you a present customer of our bank? Yes No
Would you like to apply for your loan over the phone, in person, or by mail.

Please Complete This Section

Your Name

Company Name (if applicable)

E-Mail Address (if any)

Phone Number w/Area Code

Best Time To Call

Fax Number w/Area Code

Mail Address

City, State, Zip

If you would like us to respond to your message,
please provide us with your CORRECT email address,
or phone number, and address.