New Account Application

I agree to the terms and conditions of Section 326 of the USA Patriot Act.

Preferred branch:	No Preference Ankeny Main Ankeny White Birch Oralabor Altoona Euclid East 33rd Johnston Pleasant Hill S.E. 14th Waukee

	Account Type	Opening Balance
Checking:	Simply Free Checking Community Choice Plus CSB Select 50 Plus Business Checking I Business Checking II Business Checking III [more info]	$
Savings:	Savings Money Market Certificate of Deposit IRA Business Money Market [more info]	$

Please check one
Personal Account - Single Applicant
Personal Account - Joint Applicant
Business Account

Your Contact Information

Citizenship Status:	U.S. Citizen Resident Alien Non Permanent Resident Alien Non Resident Alien Other
Date of Birth(mm/dd/yyyy):	/ /
Social Security Number / Tax ID:
Driver's License Number:
State Issued:	AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA ME MD MA MI MN MS MO MT NE NH NJ NM NY NV NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Expiration:	/ /
States lived in past 5 years:

Joint Applicant Contact Information

First Name:
MI:
Last Name:
Address:
City, State Zip:	, AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA ME MD MA MI MN MS MO MT NE NH NJ NM NY NV NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Phone
	Check here if your home phone is a cellular phone.
E-mail:

Citizenship Status:	U.S. Citizen Resident Alien Non Permanent Resident Alien Non Resident Alien Other
Date of Birth(mm/dd/yyyy):	/ /
Social Security Number / Tax ID:
Driver's License Number:
State Issued:	AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA ME MD MA MI MN MS MO MT NE NH NJ NM NY NV NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Expiration:	/ /
States lived in past 5 years:

I certify that everything I have stated in this application is correct. I understand that this application is for the purpose of opening an account and/or obtaining a Shazam Chek/ATM Card. Community State Bank must keep this application for 25 months. By clicking the "Submit Form" button, I authorize Community State Bank to order a credit report from a credit reporting agency to determine my eligibility. I understand that I must inform Community State Bank of any changes to my financial condition.

I also agree to the terms and conditions of Section 326 of the USA Patriot Act.

Applicant Signature
Typing your name in the box below will serve as your signature:

Today's date (mm/dd/yyyy): / /