Online Application

To begin, please fill out the fields in the form below. One of our representatives will contact you within one business day to complete the process.

This form supports the maximum level of encryption technology your browser allows, up to 256-bit SSL encryption to protect your personal information while it is in transit. Please view our Privacy Policy for more information.

Custom Image

Park Senior Checking

Patriot Act Notice

    Patriot Act
    Important information about procedures for opening a new account

    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.

    OK I have read the preceding Patriot Act notice is required

Primary Signer

  • Are you a new customer?

    OK Are you a new customer? is required
  • Have you had a transaction account at this or another financial institution within 12 months before making this application?

    OK Have you had a transaction account at this or another financial institution within 12 months before making this application? is required
  • OK If so, what was the name of the institution? is required
  • OK Name is required
  • Social Security Number

    - -
    OK Social Security Number is required
  • OK Driver's License Number is required
  • OK State is required
  • Drivers License Issue Date

    OK Drivers License Issue Date is required
  • Drivers License Expiration Date

    OK Date must be in the future
  • Date of Birth

    OK Date of Birth is required
  • OK Place of Birth is required
  • Home Phone

    - -
    OK Home Phone is required
  • Daytime Phone

    - -
    Optional OK Daytime Phone is required
  • Cell Phone

    - -
    OK Cell Phone is required
  • OK Mother's Maiden Name is required
  • OK Email is required
  • OK Confirm Email is required
  • OK Employer is required
  • OK Occupation is required
  • Debit card for this signer

    OK Debit card for this signer is required
  • OK How did you hear about Park State Bank? is required

Address Information

  • OK Residential Address (Not a P.O. Box) is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • Use residential address for mailing address

    OK Use residential address for mailing address is required
  • OK Mailing Address (if different than above) is required
  • OK City is required
  • OK State is required
  • OK Zip is required

Joint Signer Application

  • Number of Additional Signers on this Account

    OK Number of Additional Signers on this Account is required

Joint Applicant #1

  • OK Relationship to Primary Applicant is required
  • OK Name is required
  • Date of Birth

    OK Date of Birth is required
  • OK Place of Birth is required
  • Social Security Number

    - -
    OK Social Security Number is required
  • OK Drivers License Number is required
  • OK State Licensed Issued is required
  • Drivers License Issue Date

    OK Drivers License Issue Date is required
  • Drivers License Expiration Date

    OK Date must be in the future
  • Home Phone

    - -
    OK Home Phone is required
  • Work Phone

    - -
    OK Work Phone is required
  • Cell Phone

    - -
    OK Cell Phone is required
  • OK Residential Address is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • OK Employer is required
  • OK Occupation is required
  • Debit card for this signer

    OK Debit card for this signer is required

Joint Applicant #2

  • OK Relationship to Primary Applicant is required
  • OK Name is required
  • Date of Birth

    OK Date of Birth is required
  • OK Place of Birth is required
  • Social Security Number

    - -
    OK Social Security Number is required
  • OK Drivers License Number is required
  • OK State License Issued is required
  • Drivers License Issue Date

    OK Drivers License Issue Date is required
  • Drivers License Expiration Date

    OK Date must be in the future
  • Home Phone

    - -
    OK Home Phone is required
  • Work Phone

    - -
    OK Work Phone is required
  • Cell Phone

    - -
    OK Cell Phone is required
  • OK Residential Address is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • OK Employer is required
  • OK Occupation is required
  • Debit card for this signer

    OK Debit card for this signer is required
    Optional OK Sign me up for free online banking is required
    Optional OK Sign me up for free eStatements is required
  • Contact Preference

    OK Contact Preference is required

Comments

  • Optional OK is required

Security Code

  • OK is required

    Park State Bank reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, you grant full permission to do so.