Kasasa Saver

Personal Information

Are you a current customer?
- Yes
- No
OK Are you a current customer? is required
Name
OK Name is required
Home Phone
OK Home Phone is required
Daytime Phone
Optional OK Daytime Phone is required
Email
OK Email is required

New Customer

Date of Birth

OK Date of Birth is required
Social Security Number

- -

OK Social Security Number is required
Drivers License Number
OK Drivers License Number is required
State Licensed Issued
OK State Licensed Issued is required
Issue Date

OK Issue Date is required
Expiration Date

OK Expiration Date is required

Contact Information

Choose the location you would like to complete your application
OK Choose the location you would like to complete your application is required
How would you prefer to be contacted?
- Phone
- Mail
- Email
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?
- No
- Yes
OK Have you had a transaction account at the same or another financial institution within the 12 months immediately preceding this application? is required
Please provide the name of the Financial Institution
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?
- No
- Yes
OK Have you had a transaction account closed by a financial intermediary without consent within 12 months immediately preceding this application? is required
Please provide the reason the account was closed
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?
- No
- Yes
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

Residential Address (Not a P.O. Box)
OK Residential Address (Not a P.O. Box) is required
City
OK City is required
State
OK State is required
Zip
OK Zip is required
Use residential address for mailing address
- Yes
- No
OK Use residential address for mailing address is required
Mailing Address (if different than above)
OK Mailing Address (if different than above) is required
City
OK City is required
State
OK State is required
Zip
OK Zip is required

Joint Account Information

Number of Joint Owners on this Account
- 0
- 1
- 2
OK Number of Joint Owners on this Account is required

Joint Applicant #1

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

OK Date of Birth is required
Social Security Number

- -

OK Social Security Number is required
Drivers License Number
OK Drivers License Number is required
State Licensed Issued
OK State Licensed Issued is required
Issue Date

OK Issue Date is required
Expiration Date

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

Joint Applicant #2

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

OK Date of Birth is required
Drivers License Number
OK Drivers License Number is required
Social Security Number

- -

OK Social Security Number is required
State License Issued
OK State License Issued is required
Issue Date

OK Issue Date is required
Expiration Date

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

Personal Information

Are you a current customer?

New Customer

Date of Birth

Social Security Number

Issue Date

Expiration Date

Contact Information

How would you prefer to be contacted?

Eligibility

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

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

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?

Address Information

Use residential address for mailing address

Joint Account Information

Number of Joint Owners on this Account

Joint Applicant #1

Date of Birth

Social Security Number

Issue Date

Expiration Date

Joint Applicant #2

Date of Birth

Social Security Number

Issue Date

Expiration Date

Comments

Security Code