New Account Information

The purpose of this questionnaire is to begin the application process. All applications are subject to approval. Please note that Primary and Joint account holders will need to sign an official account form in person at Peoples State Bank before the account can be opened. For your own account security, we will also need to photocopy your driver’s license(s) or other form of a valid U.S. issued picture ID so we can have it on file to accurately identify you in the future.

How will you be applying? Individual Joint Account

Type of Account Personal Checking Money Market Savings CD IRA

I / we would like an ATM / Debit Card. Number of cards

Individual Account

First Name Middle Initial Last Name Physical Address City State Zip Code Mailing Address (if different) Cell Phone Number E-mail Address Social Security Number Driver’s License Number Expiration Date Birth Date Name of Employer Occupation Work Phone Number

Joint Applicant

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