Do you want to open an individual or joint account?*

Individual
Joint

Which account are you applying for?*

Personal Information

Name*

First Middle Last

Address - **No PO Boxes***

Street Address Address Line 2 City State ZIP Code

Eligibility*

Yes

By checking yes, you verify that you are a resident of the state of South Dakota. You understand that Black Hills Community Bank is not required to open accounts outside of their market area.

Is the United States your country of permanent residence?*

Yes
No

Do you currently rent or own your home?*

Rent
Own

How many years have you lived at your current residence?*

Previous address*

Street Address Address Line 2 City State ZIP Code

Do you have additional residences in other countries?*

Yes
No

Please list other countries of residence*

Primary Phone Number*

By entering your telephone number (landline or mobile), and clicking save or continue, you are giving us permission to contact you about this application.

Alternate Phone Number

Email Address*

Employment

Employment Status*

Employed
Unemployed
Retired

Employer

Job Title

How many years have you been with your current employer?*

Previous Employer

Job Title

How many years were you employed?

Identity

Your personal information is confidential and secure with Black Hills Community Bank. We do not share your personal information. Federal law requires that financial institutions obtain and verify personal information in order to open an account.

Date of Birth*

Social Security Number*

We obtain your social security number to help verify your identity.

Are you a citizen of the United States?*

Yes
No

Identification Type*

Drivers License
State Identification
Military Identification
Passport

ID Number*

Issuing State*

Issue Date*

DOD Number*

Passport ID*

Issuing Country*

Expiration Date*

Joint Applicant - Personal Information

Name*

First Middle Last

Address is same as primary applicant

Yes

Address - **No PO Boxes***

Street Address Address Line 2 City State ZIP Code

Eligibility*

Yes

By checking yes, you verify that you are a resident of the state of South Dakota. You understand that Black Hills Community Bank is not required to pen accounts outside of their market area.

Is the United States your country of permanent residence?*

Yes
No

Do you current rent or own your home?*

Rent
Own

How many years have you lived at your current residence?*

Previous address*

Street Address Address Line 2 City State ZIP Code

Do you have additional residences in other countries?*

Yes
No

Please list other countries of residence*

Primary Phone Number*

By entering your telephone number (landline or mobile), and clicking save or continue, you are giving us permission to contact you about this application.

Alternate Phone Number

Email Address*

Joint Applicant - Employment

Employment Status*

Employed
Unemployed
Retired

Employer

Job Title

How many years have you been with your current employer?*

Previous Employer

Job Title

How many years were you employed?*

Joint Applicant - Identity

Your personal information is confidential and secure with Black Hills Community Bank. We do not share your personal information. Federal law requires that financial institutions obtain and verify personal information in order to open an account.

Date of Birth*

Social Security Number*

We obtain your social security number to help verify your identity.

Are you a citizen of the United States?*

Yes
No

Identification Type*

Drivers License
State Identification
Military Identification
Passport

ID Number*

Issuing State*

DOD Number*

Passport ID*

Issuing Country*

Expiration Date*

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