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State Bank of Alcester
Personal Checking/Savings
Account Application


Privacy Policy:
Our privacy policy protects the privacy of your personally-identifying information that you provide us online.

Account Holders must reside in South Dakota, Southwest Minnesota, Northwest Iowa,or Northeast Nebraska. If you reside outside this area, the process will begin with our evaluation of whether we can adequately service your needs.

Important Information about Procedures for Opening a New Account
Identification Procedures Requirements: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

Security Notice:
You should ONLY fill out this Application on-line if you are using a browser with the latest security enhancements. If you don't have the latest version, download a copy now.

Instructions:
1. Complete Application and click "Submit Application" or fax it to 605-934-2515.
2. To safeguard your privacy, QUIT your browser and restart it again after using this form. This form is NOT saved in your computer's memory when you quit your browser.
3. We will contact you to sign a signature card. You may also be requested to provide photocopies of your Social Security card and Driver's License, or other documentation.

Primary Joint Account Holder Information
First Name
Middle Initial
Last Name

Current Street Address
Current City
Current State
Current Zip
Date of Birth
Social Security No.
Your E-mail Address
Home Phone
Driver's License No.
Driver's License
Issue Date
Driver's License
Expiration Date

Driver's License
Street Address
Driver's License
City
Driver's License
State
Driver's License
Zip
If driver's license is different from your current address, explain why:
Subject to backup withholding Y NWork Phone
Cell Phone
Joint Account Holder (with right of survivorship)
First Name
Middle Initial
Last Name

Current Street Address
Current City

Current State
Current Zip
Date of Birth
Social Security No.
Your E-mail Address
Home Phone
Driver's License No.
Driver's License
Issue Date

Driver's License
Expiration Date

Driver's License
Street Address
Driver's License
City

Driver's License
State
Driver's License
Zip
If driver's license is different from your current address, explain why:
Subject to backup withholding Y NWork Phone

Account Titling Information
Individual


Joint


In Trust ForName
Social Security No./Tax ID

CustodialName
Social Security No./Tax ID





I/We would like to apply for the following account(s):

Checking AccountsSavings Accounts
Free Personal Checking Regular Savings3
Personal Interest Checking1
Free Business CheckingMoney Market Accounts
BusinessPlus Checking2 Money Market Account3
MasterCard Check/ATM Card4
MasterCard Check Card4 1 2 — or — ATM Card4 - 1 2
MasterCard Photo Check Card4 1 2
1 Interest checking account cannot be held by Corporations, Partnerships, Limited Liability Partnerships, Associations, Business Trusts, Credit Unions, Mutual Insurance Companies, Crop Financing Organizations, Legal Services Plans or Farmers’ Cooperatives.  Fees may reduce earnings.
2 On BusinessPlus account, Monthly Service Fee and Activity Fees may be waived for accounts with a Previous Year Average Available Balance greater than $50,000.  Fees may reduce earnings.
3 Fees may reduce earnings. Limited to six transfers (including checks) a month (unlimited withdrawals by mail, in person or at ATMs)
4 Fees may apply. Please note: There is a $6 annual fee for the Photo Check Card.

The Internal Revenue Service does not require your consent to any provision of this document other than certification required to avoid backup withholding.

By submitting this application, I (each person jointly and severally) apply for the account(s) and Check/ATM card(s) listed above and a personal identification number. As an account owner, I am subject to all of its bylaws and rules as amended from time to time. I certify that all information given is correct. I understand and agree that for all accounts for / or, any one of us opens in the future is governed by this application, and all persons listed here will be owners, except as provided as follows: If I wish an account to have (as applicable) fewer, additional, or different owner(s), a completed, signed application for the specific account must be submitted to and accepted by State Bank of Alcester.

I agree to the terms and conditions for any accounts or services that I have now or in the future, and as they change from time to time. I agree at any time you may request information from others about my credit or accounts and that you provide to others experience information about me or my accounts with State Bank of Alcester.

I/We AGREE with the above statement