1 Contact Info 2 Account Owner / Signer Information 3 Account Information 4 Date Signed 5 Privacy Policy How can we contact you? Let's start with a little information about you. First Name * Required Middle Name Required Last Name * Required Email Address * Required Confirm Email Address * Required Address Line 1 * Required Address Line 2 City * Required State * Required Please select a state Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Northern Mariana Islands Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington U.S. Virgin Islands West Virginia Wisconsin Wyoming Zip * Required Date of Birth *Invalid Date Social Security Number *Required Phone Number *Required Account Owner / Signer Information Please answer all questions that apply. First Name * Required Middle Initial * Required Last Name * Required Street Address (PO Box holders must furnish physical address and mailing address) * Required City * Required State (ex. MN) Required Zip Code * Required Citizenship Required Social Security Number (ex. ### - ## - ####) * Required Date of Birth * Required Password * Required Home Phone Number Required Work Phone Number Required Fax Number Required Cell Phone Number * Required Email Required Driver's License Number (Or other approved photo ID#) * Required Issuing State * Required Expiration Date * Required Issue Date * Required Occupation * Required Employer * Required Account Information Please answer all questions. Type of Account * Required Select Economy Checking Regular Checking Now Account Super Now Checking Veterans Checking Premier Checking Regular Savings High Yield Savings Money Market Savings Amount of Opening Deposit * Required Source of Funds * Required Select Check Cash Internal Transfer Account Number (if applicable) Required Checks Requested? * Required Select Yes No Debit Card? * Required Select Yes No Date Signed Please put today's date. Date * Required Privacy Policy Please read and accept the privacy policy to continue. Accept Privacy Policy You're done! Thank you for completing your application! You can now begin signing your closing documents. Thank you for completing your application!Your financial institution is reviewing your application and will contact you for the next steps.You can now safely close your browser window or tab. Thank you for your submission! Your financial institution will contact you for the next steps.You can now safely close your browser window or tab. © Copyright 2024 Epic River Financial, Inc. All rights reserved. Version 23.4.3.17