Application

Personal Information

  • Are you a current customer?

    OK Are you a current customer? is required
  • OK Name is required
  • OK Home Phone is required
  • Optional OK Daytime Phone is required
  • OK Email is required

New Customer

  • 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

  • Issue Date

    OK Issue Date is required

  • Expiration Date

    OK Expiration Date is required

Contact Information

  • OK Choose the location you would like to complete your application is required

  • How would you prefer to be contacted?

    OK How would you prefer to be contacted? is required

Eligibility

  • Have you had a transaction account at the same or another financial institution within the 12 months immediately preceding this application?

    OK Have you had a transaction account at the same or another financial institution within the 12 months immediately preceding this application? is required
  • OK Please provide the name of the Financial Institution is required

  • Have you had a transaction account closed by a financial intermediary without consent within 12 months immediately preceding this application?

    OK Have you had a transaction account closed by a financial intermediary without consent within 12 months immediately preceding this application? is required
  • OK Please provide the reason the account was closed is required

  • Have you been convicted of a criminal offense because of the use of a check or other similar item within 24 months immediately preceding this application?

    OK Have you been convicted of a criminal offense because of the use of a check or other similar item within 24 months immediately preceding this application? 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

Joint Account Information

  • Number of Joint Owners on this Account

    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

  • Issue Date

    OK Issue Date is required

  • Expiration Date

    OK Expiration Date is required
  • OK Home Phone is required
  • Optional OK Daytime Phone is required
  • OK Email is required
  • OK Residential Address is required
  • OK City is required
  • OK State is required
  • OK Zip 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
  • OK Drivers License Number is required

  • Social Security Number

    - -
    OK Social Security Number is required
  • OK State License Issued is required

  • Issue Date

    OK Issue Date is required

  • Expiration Date

    OK Expiration Date is required
  • OK Home Phone is required
  • Optional OK Daytime Phone is required
  • OK Email is required
  • OK Residential Address is required
  • OK City is required
  • OK State is required
  • OK Zip is required

Comments

  • Optional OK is required

Security Code

  • OK is required

    • By submitting this form:

    • I/We certify that everything I/we have stated in this application is correct.
    • I/We authorize you to check my/our credit report history and employment history.
    • I/We authorize you to contact me/us via email with communications, advertisements, and promotions.

    A Harvest Bank employee will contact you shortly regarding your inquiry.