Plains State Bank
 

Business Deposit Application

Important Information About Procedures For Opening A New Account :

(PATRIOT ACT)

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 you 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.


Type of Account:
Business Name:   
DBA If Any:
Business Address:
Mailing Address:
Email:
Phone No: Fax: 
Tax ID No: Number of Signatures Required: 
 

Officer 1:   Title: SSN:
Home Address:
Home Phone:  Work Phone: 
Occupation:  Employer: 
Birth Date:  Birth Place:
KS Drivers license or ID # Mother's Maiden Name: 
 

Officer 2:   Title: SSN:
Home Address:
Home Phone:  Work Phone: 
Occupation:  Employer: 
Birth Date:  Birth Place:
KS Drivers license or ID # Mother's Maiden Name: 
 
If More Then Two Officer's Please Use A Copy Of This Form