New Account Setup Do you want to open an individual or joint account?* Individual Joint Which account are you applying for?*Community CashCommunity Cash BackFree Checking50 Plus CheckingPersonal InformationName* First Middle Last Physical 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 **No PO Boxes**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* Important information about procedures for opening a new accountTo 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. New customers to the bank will need to physically come to either location to sign documents in person. 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.Gender* Male Female Are you a citizen of the United States?* Yes No 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 Joint Applicant - Personal InformationName* First Middle Last Address is same as primary applicant Yes Physical 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 **No PO Boxes**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* Issue Date* Issuing State* DOD Number* Passport ID* Issuing Country* Expiration Date* MM slash DD slash YYYY CAPTCHA 24401