HTML Preview Bank Account Application Form page number 1.
Instructions: Answer all questions in order to avoid a delay in CMRB's review of application. If space is inadequate to complete response, use Continuation
Sheet (CMRB002), enter item number and remainder of response. The PRINT button can be found on page 2. To retain an electronic version of the
application form, use "Save As" option under File menu on Internet browser toolbar. Once the form is saved, it can only be modified with Adobe
Writer. If problems are encountered using form, call (225) 342-0049.
CMRB001
06-14-12
STATE OF LOUISIANA
CASH MANAGEMENT REVIEW BOARD (R.S. 39:372)
BANK ACCOUNT APPLICATION FORM
1. Applicant Agency
2. ISIS Agency Number
3. Request Type
Request for New Bank Account
Approval of an Existing Bank Account
Approval for Change in an Approved Bank Account
Account NumberAccount Name
Bank Name and City
Direct Payment of Service Charges (Schedule of Charges must be attached if State Banking Agreement will NOT be utilized)
Compensating Balance Method (Method of Calculation must be attached)
5. Method of Compensation for Bank
6. Interest Bearing Account
NoYes
7. List all other Bank Accounts Agency has Established
(Complete Item 15 on page 2 or use CMRB Continuation Sheet (CMBR002) if additional space is needed to provide applicable information)
Account Number
Account Name
Bank Name and City
Date Approved by CMRB
Purpose of the Account
Account Number
Account Name
Bank Name and City
Date Approved by CMRB
Purpose of the Account
Account Number
Account Name
Bank Name and City
Date Approved by CMRB
Purpose of the Account
Page 1 of 2
8. Explain the need for New/Change in Existing Bank Account and include why existing bank account(s) listed in item 7 above cannot be
used for this purpose.
Petty Cash
Payroll Travel
Other (specify)
4. Type of Account
Account Name
Bank Name and City