Which account are you applying for?*
Business Account Purpose*
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.
Business Entity Information
Type of Business*
DBA
Business Legal Name*
Business Description*
Federal Tax ID/EIN*

(For Sole Proprietor, enter owner's SSN)
Date of Incorporation or Established
MM slash DD slash YYYY
Business Physical Address*
Street Address Address Line 2 City State ZIP Code
Is your mailing address the same as your physical address?
- Yes
Mailing Address
Street Address Address Line 2 City State ZIP Code
Business Email Address*
Enter Email Confirm Email
Business Phone Number*
Does your business do the following?
Check Casher?*
- Yes
- No
Issuer of traveler's checks, money order, or stored value cards?*
- Yes
- No
ATM located on site?*
- Yes
- No
Engage in Internet Gambling?*
- Yes
- No
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. That means 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.
Account Signers
How many signers on the account?
For more than 4, please contact us.
Personal & Identity Information
Name*
First Middle Last
Title/Position*
Date of Birth*
MM slash DD slash YYYY
Social Security Number*

(We obtain your social security number to help verify your identity.)
Gender*
- Male
- Female
Identification
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.
Identification Type*
- Drivers License
- State Identification
- Military Identification
- Passport
ID Number*
Issue Date*
Issuing State*
DOD Number*
Passport ID*
Issuing Country*
Expiration Date*
MM slash DD slash YYYY
Are you a citizen of the United States?*
- Yes
- No
Address & Contact Information
Address*
Street Address Address Line 2 City South Dakota ZIP / Postal Code Country
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*
Enter Email Confirm Email
Account Signer 2
Personal & Identity Information
Name*
First Middle Last
Title/Position*
Date of Birth*
MM slash DD slash YYYY
Social Security Number*

(We obtain your social security number to help verify your identity.)
Gender*
- Male
- Female
Identification
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.
Identification Type*
- Drivers License
- State Identification
- Military Identification
- Passport
ID Number*
Issue Date*
Issuing State*
DOD Number*
Passport ID*
Issuing Country*
Expiration Date*
MM slash DD slash YYYY
Are you a citizen of the United States?*
- Yes
- No
Address & Contact Information
Address*
Street Address Address Line 2 City South Dakota ZIP / Postal Code Country
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*
Enter Email Confirm Email
Account Signer 3
Personal & Identity Information
Name*
First Middle Last
Title/Position*
Date of Birth*
MM slash DD slash YYYY
Social Security Number*

(We obtain your social security number to help verify your identity.)
Gender*
- Male
- Female
Identification
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.
Identification Type*
- Drivers License
- State Identification
- Military Identification
- Passport
ID Number*
Issue Date*
Issuing State*
DOD Number*
Passport ID*
Issuing Country*
Expiration Date*
MM slash DD slash YYYY
Are you a citizen of the United States?*
- Yes
- No
Address & Contact Information
Address*
Street Address Address Line 2 City South Dakota ZIP / Postal Code Country
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*
Enter Email Confirm Email
Account Signer 4
Personal & Identity Information
Name*
First Middle Last
Title/Position*
Date of Birth*
MM slash DD slash YYYY
Social Security Number*

(We obtain your social security number to help verify your identity.)
Gender*
- Male
- Female
Identification
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.
Identification Type*
- Drivers License
- State Identification
- Military Identification
- Passport
ID Number*
Issue Date*
Issuing State*
DOD Number*
Passport ID*
Issuing Country*
Expiration Date*
MM slash DD slash YYYY
Are you a citizen of the United States?*
- Yes
- No
Address & Contact Information
Address*
Street Address Address Line 2 City South Dakota ZIP / Postal Code Country
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*
Enter Email Confirm Email
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Save and Continue Later

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Business Entity Information

Does your business do the following?

Important information about procedures for opening a new account

Account Signers

Personal & Identity Information

Identification

Address & Contact Information

Account Signer 2

Personal & Identity Information

Identification

Address & Contact Information

Account Signer 3

Personal & Identity Information

Identification

Address & Contact Information

Account Signer 4

Personal & Identity Information

Identification

Address & Contact Information