New Savings Setup Do you want to open an individual or joint account?* Individual Joint Which account are you applying for?*Treehouse SavingsRegular SavingsCommunity Tiered Money MarketHealth Savings AccountPersonal InformationName* First Middle Last Address - **No PO Boxes*** Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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.Are You a U.S. Citizen?* Yes No Do you currently rent or own your home?* Rent Own How many years have you lived at your current residence?*Less than 1 year1-2 years2-4 years5+ yearsPrevious address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 NumberEmail Address* EmploymentEmployment 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? IdentityYour 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* MM slash DD slash YYYY 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* MM slash DD slash YYYY Joint Applicant - Personal InformationName* First Middle Last Address is same as primary applicant Yes Address - **No PO Boxes*** Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 NumberEmail Address* Joint Applicant - EmploymentEmployment 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 - IdentityYour 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* MM slash DD slash YYYY 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* MM slash DD slash YYYY CAPTCHA 12079