New Business Account Application

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Business Information:

LLC

Corporation

Partnership

Sole Proprietorship

Business Name:

Street Address:

City:

State:

Zip Code:

EIN:

Business Phone Number:

Website:

Email Address:

Nature of Business:

Date of Establishment:

State of Registration:

Signer Information: Individual Opening the Account on Business' Behalf

First Name:

Middle Initial:

Last Name:

Street Address:

City:

State:

Zip Code:

SSN:

Date of Birth:

Driver's License Number:

Driver's License Expiration Date:

Drivers License State:

Primary Phone Number:

Work Phone Number:

Email Address:

Title/Position with the business:

Employer (if different than business):

Requested Account Type(s):

Savings

Checking

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Submit this information and a Security State Bank employee will contact you.

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515-733-5311

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641-487-7521

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