Account Inquiry Application

Please complete this secure form and a Adams State Bank representative will contact you by the end of the next business day to answer any questions you may have and finish the process. Thank you for choosing Adams State Bank!

Fields marked with asterisks are required.

Deposit Account Customer Information (Owner)

Full Name *

Type of Account *

Social Security Number (last 4 digits) *

Physical Address Street *

Physical Address City *

Physical Address State *

Physical Address Zip *

Mailing Address Street *

Mailing Address City *

Mailing Address State *

Mailing Address Zip *

Employer *

Occupation *

Drivers License Number *

Drivers License State *

Drivers License Expiration (MM/DD/YYYY)*

Date of Birth (MM/DD/YYYY)*

Primary Phone *

Email *

Notes

Would you like to sign up for Estatements?*

YES NO

Would you like to sign up for remote deposit?*

YES NO

Deposit Account Customer Information (Co-Owner)

Full Name

Social Security Number (last 4 digits)

Co-Owner's Physical Address Street

Co-Owner's Physical Address City

Co-Owner's Physical Address State

Co-Owner's Physical Address Zip

Co-Owner's Mailing Address Street

Co-Owner's Mailing Address City

Co-Owner's Mailing Address State

Co-Owner's Mailing Address Zip

Drivers License Number

Drivers License State

Employer

Occupation

Drivers License Expiration (MM/DD/YYYY)

Date of Birth (MM/DD/YYYY)

Primary Phone

Notes

There was an error submitting the form

Thank you for your submission!
To open the account, a copy of identification, social security number, signatures, and a credit check will be required. We will be in touch with you soon.