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 Business Account / Business Loan Application Request

  Please fill out the form below and we will contact you about the type of relationship you would like.  Do not submit account numbers or other sensitive information using this form.
  Are you a resident of the State of New Mexico, or do you have accounts with Los Alamos National Bank? *  Yes  No
  1. Your Full Name:
  2. Name of your Business:
3. Type of account:  
  4. Contact Me By:  
       Email Address   AND/OR
  5. Any additional information?