Personal Accounts Application

To Apply, having already read and accepted account disclosures, simply complete and submit application. Upon approval, Union State Bank/Bank of Atchison, will send to you a new account packet. After executing the enclosed documents as indicated, return to us to activate your account.

A representative from Union State Bank/Bank of Atchison may contact you to verify your account application. Feel free to contact us with any questions you may have.

* = Required Field

All applicants must complete Section A.
If you are applying for a consumer deposit account, complete Sections A and B.
If you are applying for a consumer loan, complete Sections A and C.
If you are applying for both deposit and loan accounts, complete all three sections.


If you work in Kansas or Missouri and reside outside of Kansas or Missouri please contact us.
I am applying for:
(check all that apply)
DEPOSIT ACCOUNTS

My Rewards Checking
Free Checking
E-Checking
Regular Checking
EZ Checking
Silver Checking
Status Checking
Value Checking
Now Checking
Super Now Checking
Money Market
CDs

LOANS

Consumer Loans
Auto Loans
SECTION A - General Information
Last Name:*
First Name:*
Middle Initial:*
Home Address :*
City:*
State:

Zip Code:*
Mailing Address (if applicable):
City:
State:
Zip Code:
Previous Home Address:
City:
State:
Zip Code:
Home Phone (please include area code):*
Email Address:
Fax:
Date of Birth:*
Social Security Number:*
Employer:*
Employer Address:
City:
State:
Zip Code:
Employer Telephone:
Years There:
Position / Title:

Previous Employer (if less than 2 years at current employment): Previous Employer Address:

City:
State:
Zip Code:
Please Select Individual or Joint Application, by selecting "Joint" this shows your intention to apply for joint credit.

Last Name:
First Name:
Middle Initial:
Home Address :
City:
State:
Zip Code:
Previous Home Address:
City:
State:
Zip Code:
Home Phone (please include area code):
Email Address:
Fax:
Date of Birth:
Social Security Number:
Employer:
Employer Address:
City:
State:
Zip Code:
Employer Telephone:
Years There:
Position / Title:

Previous Employer (if less than 2 years at current employment): Previous Employer Address:

City:
State:
Zip Code:
SECTION B - Deposit Account Information
CD Term:
(This is only if you choose a Certificate of Deposit)
CD Interest:
(This is only if you choose a Certificate of Deposit)
Amount of Initial Deposit:
How Initial Deposit Will Be Made: I will mail a check to Union State Bank/Bank of Atchison
Incoming Wire
Debit my existing Union State Bank/Bank of Atchison account
Account Number
Debit my current Bank
(You will receive a form for authorization)
Bank Name
Account Number
ABA Number
Please Provide The Following Verification Information:
Name of Current Bank:
Address of Bank:
City:
State:
Zip Code:
Account Number :
KS/MO Drivers License or State Issue ID Number:*
Are you a US Citizen?
Yes
No
NOTE: If you do not have a drivers license or state issued ID, please call one of our Customer Service Representatives at (785) 548 - 7521
Nearest Relative Not Living With You:
Address:
City:
State:
Zip Code:
Phone Number (including area code):
Mother's Maiden Name (for security purposes):
The Following Services Are Subject To Credit Approval:
*Would you like to apply for an Union State Bank/Bank of Atchison Debit Card?:
Yes     No
*Would you like to apply for overdraft protection?:
Yes     No
If yes, please complete Income Information in Section C of this application
SECTION C - Loan Application Information
Purpose of Loan: Amount Requested:
Length of Repayment Requested:
This is a/an Application, by selecting "Joint" this shows your intention to apply for joint credit.

The Co-Applicant section and all other Co-Applicant questions should be completed to the extent possible if: (1) co-applicant will be jointly obligated with you on the loan; (2) you will be relying on income or assets of the co-applicant as a basis for repayment of the loan; (3) you are relying on income from alimony, child support or separate maintenance from the co-applicant or other party; or (4) you are married to the co-applicant and reside in, or the property is located in, a community property State, if you are married, your spouse need not be jointly obligated with you on the loan and need not sign as a co-applicant unless Item (2) above applies or unless the spouse's signature is required under state law to create a valid lien, pass clear title or waive inchoate rights to property.
Applicant:
Marital Status: Do not complete if this is an application for individual unsecured credit.
*Unmarried (single, divorced, or widowed)
Gross Annual Income:
(NOTE: Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation)
Do you own your own home (or other real estate you would offer as collateral): Yes No
If yes, please provide the value of that real estate:
Amount of First Mortgage: Amount of Second Mortgage:
Co-Applicant:     
Marital Status: Do not complete if this is an application for individual unsecured credit.
*Unmarried (single, divorced, or widowed)
Gross Annual Income:
(NOTE: Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation)
Do you own your own home (or other real estate you would offer as collateral): Yes No
If yes, please provide the value of that real estate:
Amount of First Mortgage: Amount of Second Mortgage:
Information for Government Monitoring Purposes:
*Note, fill this section out only if application is for Purchase or Refinance of Primary Residence
The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may discriminate neither on the basis of this information, nor on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation or surname. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)
Applicant:
Applicant: I do not wish to furnish this information
Ethnicity:

 

Race: (Check all that apply)

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Asian

White

Black or African American

Sex:
Co-Applicant:
Co-Applicant: I do not wish to furnish this information
Ethnicity:

 

Race: (Check all that apply)

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Asian

White

Black or African American

Sex:
BY CLICKING ON THE SUBMIT BUTTON BELOW, I (WE) APPLY FOR THE LOAN AND/OR DEPOSIT PRODUCTS LISTED ABOVE AND CERTIFY THAT ALL INFORMATION PROVIDED ABOVE IS CORRECT AND AUTHORIZE YOU TO CHECK MY (OUR) CREDIT AND VERIFY THE INFORMATION PROVIDED IN THIS APPLICATION. I (WE) ALSO CERTIFY UNDER PENALTY OF PERJURY THAT THE SOCIAL SECURITY NUMBER(S) PROVIDED ABOVE IS/ARE CORRECT AND THAT I AM NOT (WE ARE NOT) SUBJECT TO BACKUP WITHHOLDING UNDER THE INTERNAL REVENUE CODE. I (WE) UNDERSTAND THAT ADDITIONAL INFORMATION MAY BE REQUIRED BEFORE A DECISION CAN BE MADE REGARDING THIS APPLICATION. I (WE) FURTHER UNDERSTAND THAT APPROVAL BY Union State Bank/Bank of Atchison FOR ANY OF THE LOAN OR DEPOSIT PRODUCTS IS CONDITIONED ON MY (OUR) AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS CONTAINED IN THE APPLICABLE LOAN AGREEMENT AND/OR DEPOSIT AGREEMENT. I FURTHER AGREE TO RETURN ANY ACCESS DEVICE FOR OBTAINING FUNDS FROM ANY TYPE OF ACCOUNT UPON DEMAND BY Union State Bank/Bank of Atchison.
I HAVE READ THE ABOVE STATEMENT AND AGREE TO THE TERMS SET OUT THEREIN.