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.

* Indicates Required Information

Select Account(s) *

Accont Holder Information

Primary Owner

Joint Owner

Ownership of Account

Important Notice: The type of account you select may determine how property passes on your death. Your will may not control the disposition of funds held in some of the following accounts.

  • Single-Party Account with P.O.D.(Payable On Death) Designation.

    The party to the account owns the account. On the death of the party, ownership of the account passes to the P.O.D. beneficiaries of the account. The account is not part of the party’s estate.

  • Single-Party Account without P.O.D.(Payable On Death) Designation.

    The party to the account owns the account. On the death of the party, ownership of the account passes as a part of the party’s estate under the party’s will or by intestacy.

  • Multiple-Party Account with R.O.S.(Right Of Survivorship).

    The parties to the account owns the account in proportion to the parties’ net contributions to the account. The financial institution may pay any sum in the account to a party at any time. On the death of a party, the party’s ownership of the account passes to the surviving parties.

  • Multiple-Party Account without R.O.S.(Right Of Survivorship)

    The parties to the account owns the account in proportion to the parties’ net contributions to the account. The financial institution may pay any sum in the account to a party at any time. On the death of a party, the account party’s ownership of the account passes as a part of the party’s estate under the party’s will or by intestacy.

  • Multiple-Party Account with R.O.S.(Right Of Survivorship) and P.O.D. (Payable On Death) Designation.
    The parties to the account owns the account in proportion to the parties’ net contributions to the account. The financial institution may pay any sum in the account to a party at any time. On the death of the last surviving party, the ownership of the account passes to the P.O.D. beneficiaries.

Personal Accounts

Commercial Accounts

Account Setup Information

Check Options

Additional Services

Attachments

To further expedite your application, please attach a copy of your driver’s license and Secondary form of ID (e.g. Social Security, Voters Registration, Medical Ins Card, etc..)

If there are any other attachments that you feel would be beneficial, you may securely attach them here. If specific documents are required for processing your request, we will be in contact with you following our receipt of your application.  (Allowed file types include: doc, docx, pdf, zip, rtf, tif, jpg, and gif)

Important Notice: Maximum combined file size of 5MB. Internet Explorer users, you may receive an Active X warning when selecting files. This is our form checking the size of your upload files, and is normal. Please click Yes.

Certification

I certify that I am at least 18 years of age and I have accurately and fully completed all items on this application. Under penalties of perjury, I certify that:

  1. The social security number (SSN) and/or tax payer identification number (TIN) shown above is my correct number;
  2. I am NOT subject to backup withholding because (a) I am exempt from backup witholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the Internal Revenue Service has notified me that I am no longer subject to backup withholding; and
  3. I am a U.S. person (including a U.S. resident alien). 

Or check all that apply:

The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

Please note, this application is subject to verification and approval. In order for us to process your application correctly, we may need to contact you to verify some of the information or request additional documentation. When you submit this application, you certify that everything stated above is true and accurate. I understand and agree that if the institut ion is not able to verify the identity of all the owners of this account within a reasonable time, it may, at anytime, in its sole discretion, without providing advance notice, close the account.

If you have any questions, please contact us at (580) 562-4871, or by e-mail at info@washitastatebank.com

By clicking below, I hereby certify that everything I have stated above is correct. You may keep this application whether or not it is approved. By clicking below, I understand that verification is done through Telecheck and OFAC.