Senath State Bank Checking/Savings Account Application
Please print this form, fill it out and fax to 573-738-2108
 Account Information
 Will there be a co-applicant on this application?    Yes    No
 I am interested in:
    Checking Account
        Type of Checking Account:  ____________________________________________
        Initial Deposit Amount:  $_______________________________________________
        Source of Deposit:
           Transfer from a current account.   Account Number:  _____________________
           I will transfer funds from another institution.
           I will mail a check/money order.
           Other.   (please describe)  _________________________________________
    Savings Account
        Type of Savings Account:  _____________________________________________
        Initial Deposit Amount:  $_______________________________________________
        Source of Deposit:
           Transfer from a current account.   Account Number:  _____________________
           I will transfer funds from another institution.
           I will mail a check/money order.
           Other.   (please describe)  _________________________________________
    Other Account
        Description:  ________________________________________________________
        Initial Deposit Amount:  $_______________________________________________
        Source of Deposit:
           Transfer from a current account.   Account Number:  _____________________
           I will transfer funds from another institution.
           I will mail a check/money order.
           Other.   (please describe)  _________________________________________
 I am also interested in:
    ATM Card
    ATM and Check/Debit Card
    Credit Card
    Direct Deposit
    Other   (please describe)  ______________________________________________
 Primary Applicant
 Last Name:  Account Number:
 First Name:  Middle Name:
 Social Security Number (TIN):  Date of Birth:
 Home Phone Number:  Work Phone Number:
 Other Phone Number:  Email Address:
 Drivers License #:  Drivers License State:
 Mother's Maiden Name:  Present Employer Name:
 Home Address
 Address 1: 
 Address 2: 
 City:  State, Zip:
 Co-Applicant
 Last Name:  Account Number:
 First Name:  Middle Name:
 Social Security Number (TIN):  Date of Birth:
 Home Phone Number:  Work Phone Number:
 Other Phone Number:  Email Address:
 Drivers License #:  Drivers License State:
 Mother's Maiden Name:  Present Employer Name:
 Home Address
 Address 1: 
 Address 2: 
 City:  State, Zip:
 Additional Information
 How would you prefer to be contacted?
  Home Phone
  Work Phone
  Other Phone
  Email Address
  Other:
 Special Instructions/Comments:
 
 
 
 Signatures
 Primary Applicant Signature:  Date:        
 Co-Applicant Signature:  Date: