New Account Kit from Prairie State Bank and Trust

Select a Branch

Please select a branch from the following list:

Single Owner Information

(All fields required)

Legal Name

Street Address

Mailing Address (if different)

City

State

Zip Code

Primary Telephone HomeCell

Work Telephone

Social Security Number

Driver's License Number

Driver's License State Issued

Driver's License Issue Date

Driver's License Expiration Date

Date of Birth

Employer

Occupation

Joint Owner

(All fields required for joint accounts)

Legal Name

Street Address

Mailing Address (if different)

City

State

Zip Code

Primary Telephone HomeCell

Work Telephone

Social Security Number

Driver's License Number

Driver's License State Issued

Driver's License Issue Date

Driver's License Expiration Date

Date of Birth

Employer

Occupation

Please select the type of account(s) that you would like to open:

To determine the account that best fits your needs, please select any of the following characteristics of your current banking practices:

It is important to me to earn interest on my deposit accounts.

On average I maintain a balance of .

I enjoy using the following free technology products: Online Banking
Online Bill Pay
Mobile Banking
Mobile Deposit
Money Management Software

I use my debit card on average times per month.

I primarily make purchases by: Check
Debit Card
Other

I primarily pay bills by: Check
Debit Card
Online Bill Pay
Other

What is the best time of day and phone number to reach you?

Time

Phone Number

Security Questions for Primary Owner

Please choose three of the security questions to help us easily verify your identity when you call the bank to request information. Joint owners will complete these questions when they come to the bank to sign the Signature Card.

1). 4 to 8 character passcode (alpha and/or numeric)

2). What was your childhood nickname?

3). In what city did you meet your spouse/significant other?

4). What is your oldest sibling's birthday, month, and year?

5). What is the middle name of your oldest child?

6). What is your oldest cousin's first and last name?

7). In what city or town was your first job?

8). What is the name of the place your wedding reception was held?

9). What was the first concert you attended?

10). Who was your childhood hero?

11). What was your dream job as a child?

12). What was the color of your first car?

13). What is your paternal grandmother's first name?

14). What was the first street you lived on?

Direct Deposit Information

Please provide the following information if you would like your payroll to be directly deposited in to your new Prairie State Bank & Trust account. We will provide you with a Change of Automated Deposit letter for your employer(s).

Primary Owner Payroll

Recipient's Name

Employer's Name

Employer's Street Address

Employer's City, State and Zip Code

Previous Bank

Previous Bank Acct #

Joint Owner Payroll

Recipient's Name

Employer's Name

Employer's Street Address

Employer's City, State and Zip Code

Previous Bank

Previous Bank Acct #

Automatic Payment Information

If you have established or would like to establish automatic payments from your account, enter the information below. We will provide Change of Automatic Payment notices for you to provide to the payees.

Do not include items that you want to pay by check or bill pay. Common automatic withdrawals are home mortgage payments, auto loans, utilities, internet/cable, insurance premiums, credit cards, investments, charitable donations, subscriptions, and memberships.

Payment #1

Name of Company

Account Number

Street Address

City, State and Zip Code

Amount

Day of month to be paid

Payment #2

Name of Company

Account Number

Street Address

City, State and Zip Code

Amount

Day of month to be paid

Payment #3

Name of Company

Account Number

Street Address

City, State and Zip Code

Amount

Day of month to be paid

Payment #4

Name of Company

Account Number

Street Address

City, State and Zip Code

Amount

Day of month to be paid

Questions/Comments

Important information about procedures for opening a new account - To 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. What this means for you: 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.

Personalized Mortgage Products

New Account Kit

Select a Branch

Single Owner Information

Joint Owner

Please select the type of account(s) that you would like to open:

To determine the account that best fits your needs, please select any of the following characteristics of your current banking practices:

What is the best time of day and phone number to reach you?

Security Questions for Primary Owner

Direct Deposit Information

Primary Owner Payroll

Joint Owner Payroll

Automatic Payment Information

Payment #1

Payment #2

Payment #3

Payment #4