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Park State Bank
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Deposit Inquiry


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Primary Applicant:
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Joint Applicant:

Contact Information:
Preferred Method of Contact

Account(s) you are interested in:

Applicant questions:
Have you had a transaction account at this or another financial intermediary within 12 months of making this application?
Applicant*
Joint Applicant
Have you had a transaction account closed by a financial intermediary without your consent within 12 months of making this application?
Applicant*
Joint Applicant
Have you been convicted of a criminal offense for the use of a check or similar item within 24 months of this application?
Applicant*
Joint Applicant
Important information & signatures:

To help the government fight 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 apply to open a new account, we will ask you for your name, physical address, date of birth, social security number, and unexpired government issued photo ID, and other information that will allow us to identify you. We may also ask to see other identifying documents. Acceptable forms of identification needed to open an account are a driver’s license, state ID, passport, military ID, and certain tribal IDs. If you make a false material statement in this document that you do not believe to be true, you are guilty of perjury.

The undersigned agrees that all information is accurate and authorizes the financial institution to verify credit and employment history.

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Your form is being processed.
Thank you for your application!
We will be in touch with you within 2 business days.  Thank you for choosing Park State Bank.