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State Bank of Alcester
Personal Checking/Savings
Account Application

Privacy Policy:
The State Bank of Alcester Privacy Policy protects the privacy of your personally-identifying information that you provide us online. By submitting the application, you agree that you have read and understand the Privacy Policy.

At least one applicant must be 18 years or older and must reside in South Dakota, Southwest Minnesota, Northwest Iowa or Northeast Nebraska. If you reside outside this area, the process will begin with the bank's evaluation of whether the bank 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, the bank will ask for your name, address, date of birth and other information that will allow us to identify you.

The purpose of this questionnaire is for the bank to gather some information, so you can begin
the process of opening an account.

Security Notice:
You should ONLY fill out this Application online 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. The bank will contact you to sign a signature card. You may also be requested to provide
photocopies of your Social Security card, driver's license or other documentation.

Primary Account Holder Information
First Name
Middle Initial
Last Name

Current Street Address
Current City
Current State
Current Zip
Mailing Address (if different) 
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
Issuing State
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 N
Work 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
Mailing Address (if different) 
Date of Birth
Social Security No.
Your Email Address
Home Phone
Driver's License No.
Driver's License
Issue Date

Driver's License
Expiration Date
Driver's License
Issuing State
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
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 Savings2
Personal Interest Checking1Money Market Accounts
MasterCard Check/ATM Card4 Money Market Account2
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 Fees may reduce earnings. Limited to six transfers (including checks) a month (unlimited withdrawals by mail, in person or at ATMs)
3 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.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, you (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, you are subject to all of its bylaws and rules as amended from time to time.
You certify that all information given is correct. You understand and agree that for all accounts, any one of you opens in the future is governed by this application, and all persons
listed here will be owners, except as provided as follows: If you 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.

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

You AGREE with the above statement