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.

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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

Business Information

  • OK Business Name is required
  • OK Business Type is required
  • OK Contact Name is required
  • OK Permanent 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
  • Business Phone

    - -
    OK Business Phone is required
  • Business Fax

    - -
    Optional OK Business Fax is required
  • Business Cell Phone

    - -
    Optional OK Business Cell Phone is required
  • OK Tax ID Number is required
  • OK E-mail is required
  • OK Confirm E-mail is required
  • OK How did you hear about Park State Bank? 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 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 Drivers License Expiration Date is required
  • 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

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 Drivers License Expiration Date is required
  • 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 Licensed Issued is required
  • Drivers License Issue Date

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

    OK Drivers License Expiration Date is required
  • 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

Contact Information

  • Optional OK Choose the location you would like to complete your application: is required
  • How would you prefer to be contacted?

    Optional OK How would you prefer to be contacted? is required
  • When is the best time to arrange an appointment?

    Optional OK When is the best time to arrange an appointment? 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.