PriorityOne Bank is currently only serving residents of the state of Mississippi. Before proceeding, please confirm your eligibility below:

    OK By checking this box I confirm that I am a resident of the state Mississippi is required
  • Anyone under the age of 18 must have a parent or legal gaurdian secondary owner on this account

  • Are you 18 or older?

    OK Are you 18 or older? is required
  • Do you currently have a checking account with our institution?

    OK Do you currently have a checking account with our institution? is required

Personal Information:

  • OK Name is required
  • Social Security Number

    - -
    OK Social Security Number is required
  • Date of Birth

    OK Date of Birth is required
  • Home Phone

    - -
    OK Home Phone is required
  • Daytime Phone

    - -
    Optional OK Daytime Phone is required
  • OK Mother's Maiden Name is required
  • OK Email is required
  • OK Occupation or Former Occupation is required
  • OK Employer or Former Employer is required
  • OK Will You Deposit or Withdraw Cash is required
  • OK Approximately How Much a Month is required
  • OK Will You Receive or Send Wires is required
  • OK Citizenship is required
  • Are You or Your Immediate Family a Politically Exposed Person or an Associate of Someone Who is

    OK Are You or Your Immediate Family a Politically Exposed Person or an Associate of Someone Who is is required

Address Information:

  • OK Residential Address (Not a P.O. Box) is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • Use residential address for mailing address

    OK Use residential address for mailing address is required
  • OK Mailing Address (if different than above) is required
  • OK City is required
  • OK State is required
  • OK Zip is required

Identification

  • What form of ID would you prefer to use?

    OK What form of ID would you prefer to use? is required

Drivers license or state-issued ID

  • OK License Number is required
  • OK State is required
  • OK Issue Date is required
  • OK Expiration Date is required

US Passport

  • OK Passport Number is required
  • OK Expiration Date is required

Tax Status

    Optional OK I am not subject to backup withholding. This is most common. Under penalties of perjury, I certify that: 1. My Social Security number is correct, 2. I am not subject to backup withholding because (a) I am exempt from backup withholding, (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 IRS has notified me that I am no longer subject to backup withholding, 3. I am a U.S. citizen or U.S. resident alien, and 4. I am exempt from FATCA reporting. is required
    Optional OK I am subject to backup withholding. You will know if this applies to you. Under penalties of perjury, I certify that: 1. My Social Security number is correct, 2. I am subject to backup withholding because I have 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, 3. I am a U.S. person or U.S. resident alien, and 4. I am exempt from FATCA reporting. is required
  • Debit Card

    OK Debit Card is required

Opening Deposit

  • How would you like to make your opening deposit?

    OK How would you like to make your opening deposit? is required
  • What kind of account is your funding account?

    OK What kind of account is your funding account? is required
  • Funding Source Account Holder

    OK Funding Source Account Holder is required
  • OK Routing Number is required
  • OK Financial Institution Name is required
  • OK Account Number is required
  • OK Verify Account Number is required
  • OK Amount to transfer (Opening deposit between $50-$100) is required
  • OK Verify Amount is required
    OK By clicking this box, I agree the information entered above is true and accurate. I hereby authorize the financial institution to initiate an Automated Clearing House (ACH) debit and if necessary, to initiate a credit entry to correct an erroneous debit entry, from my account information above in my name payable to the financial institution in which I am applying for an account at and for an amount in which I have specified above. I understand this request to fund my account will not be processed until I check this box and the account has been completely approved by the financial institution. Once I select the Submit button, I understand that I may not revoke this transaction due to the short timeframe between approval and transmission of this entry. is required

Additional Information:

  • Number of Joint Owners on this Account

    Optional OK Number of Joint Owners on this Account is required

Joint Applicant #1:

  • OK Relationship to Primary Applicant is required
  • OK Name is required
  • Date of Birth

    OK Date of Birth is required
  • Social Security Number

    - -
    OK Social Security Number is required
  • OK Drivers License Number is required
  • OK State Licensed Issued is required
  • Home Phone

    - -
    OK Home Phone is required
  • Work Phone

    - -
    OK Work Phone is required
  • OK Residential Address is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • OK Occupation or Former Occupation is required
  • OK Employer or Former Employer is required
  • OK Will You Deposit or Withdraw Cash is required
  • OK Approximately How Much a Month is required
  • OK Will You Receive or Send Wires is required
  • OK Citizenship is required
  • Are You or Your Immediate Family a Politically Exposed Person or an Associate of Someone Who is

    OK Are You or Your Immediate Family a Politically Exposed Person or an Associate of Someone Who is is required

Identification

  • What form of ID would you like to use?

    OK What form of ID would you like to use? is required

Drivers license or state-issued ID

  • OK State is required
  • OK License Number is required
  • OK Issue Date is required
  • OK Expiration Date is required

US Passport

  • OK Passport Number is required
  • OK Expiration Date is required

Tax Status

    Optional OK I am not subject to backup withholding. This is most common. Under penalties of perjury, I certify that: 1. My Social Security number is correct, 2. I am not subject to backup withholding because (a) I am exempt from backup withholding, (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 IRS has notified me that I am no longer subject to backup withholding, 3. I am a U.S. citizen or U.S. resident alien, and 4. I am exempt from FATCA reporting. is required
    Optional OK I am subject to backup withholding. You will know if this applies to you. Under penalties of perjury, I certify that: 1. My Social Security number is correct, 2. I am subject to backup withholding because I have 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, 3. I am a U.S. person or U.S. resident alien, and 4. I am exempt from FATCA reporting. is required
  • Debit Card

    OK Debit Card is required

Joint Applicant #2:

  • OK Relationship to Primary Applicant is required
  • OK Name is required
  • Date of Birth

    OK Date of Birth is required
  • Social Security Number

    - -
    OK Social Security Number is required
  • OK Drivers License Number is required
  • OK State License Issued is required
  • Home Phone

    - -
    OK Home Phone is required
  • Work Phone

    - -
    OK Work Phone is required
  • OK Residential Address is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • OK Occupation or Former Occupation is required
  • OK Employer or Former Employer is required
  • OK Will You Deposit or Withdraw Cash is required
  • OK Approximately How Much a Month is required
  • OK Will You Receive or Send Wires is required
  • OK Citizenship is required
  • Are You or Your Immediate Family a Politically Exposed Person or an Associate of Someone Who is

    OK Are You or Your Immediate Family a Politically Exposed Person or an Associate of Someone Who is is required

Identification

  • What form of ID would you like to use?

    OK What form of ID would you like to use? is required

Drivers license or state-issued ID

  • OK State is required
  • OK License Number is required
  • OK Issue Date is required
  • OK Expiration Date is required

US Passport

  • OK Passport Number is required
  • OK Expiration Date is required

Tax Status

    Optional OK I am not subject to backup withholding. This is most common. Under penalties of perjury, I certify that: 1. My Social Security number is correct, 2. I am not subject to backup withholding because (a) I am exempt from backup withholding, (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 IRS has notified me that I am no longer subject to backup withholding, 3. I am a U.S. citizen or U.S. resident alien, and 4. I am exempt from FATCA reporting. is required
    Optional OK I am subject to backup withholding. You will know if this applies to you. Under penalties of perjury, I certify that: 1. My Social Security number is correct, 2. I am subject to backup withholding because I have 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, 3. I am a U.S. person or U.S. resident alien, and 4. I am exempt from FATCA reporting. is required
  • Debit Card

    OK Debit Card is required
  • Please enter any additional information you would like us to know... OK Additional Comments is required

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    Security Code

  • OK is required
  • By clicking submit below, I/we acknowledge that I/we have read the Account Disclosure and Privacy Policy and agree to the terms and conditions described therein. PriorityOne Bank reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, I/we grant full permission to do so.

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