Applicant Information

Age Requirement

You must be 18 years of age or older in order to open an account online with Home State Bank. If you are not at least 18 years old and would like to open an account with Home State Bank, please visit one of our branch locations and one of our representatives will be happy to assist you.

• • By checking this box, I confirm that I am at least 18 years of age.
  OK By checking this box, I confirm that I am at least 18 years of age. is required

Eligibility

Home State Bank is only accepting applications from residents of the State of Minnesota.

• • By checking this box, I confirm I am a resident in the State of Minnesota.
  OK By checking this box, I confirm I am a resident in the State of Minnesota. is required

• Please enter the code to confirm your ability to view the required Portable Document Format (PDF) files. If the code isn't visible, click here to see code in new window or visit your nearest branch to apply for an account.

  We ask that you confirm your ability to download, open, and view the required Portable Document Format (PDF) files. Once you have entered the confirmation code, you may close the PDF document and continue the application process.

  
  

  Click here for your confirmation code.

• Enter code
  OK Error - Please enter the code to verify that you can view the required Portable Document Format (PDF) files. If the code isn't visible you will need to visit your nearest branch to apply for an account.

Basic Info

• First Name
  OK First Name is required
• Last Name
  OK Last Name is required
• Email Address
  OK Email Address is required
• Phone
  OK Phone is required
• Date of Birth
  OK Date of Birth is required
• Social Security Number
  OK Social Security Number is required

Address

• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip Code
  OK Zip Code is required
• • Mailing address is different (Optional)
  OK Mailing address is different (Optional) is required

Mailing Address

• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip Code
  OK Zip Code is required

Previous Address

• Have you lived at this address for less than 2 years?

  • No
  • Yes
  OK You must select one of the following.
• Previous Address
  OK Previous Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip Code
  OK Zip Code is required

Identification

• What form of ID would you prefer to use?

  • Drivers license or state-issued ID
  • US Passport
  OK What form of ID would you prefer to use? is required
• License Number
  OK License Number is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Issued Date
  OK Issued Date is required
• Expiration Date
  OK Expiration Date is required
• Passport Number
  OK Passport Number is required
• Expiration Date
  OK Expiration Date is required

Tax Status

• • 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.
  • 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.
  OK Please select one of the following.

What is this?

If you have any questions about how to complete this section please download instructions.

Additional Information

• Work Phone
  OK Work Phone is required
• Cell Phone
  OK Cell Phone is required
• Occupation
  OK Occupation is required
• Employer
  OK Employer is required
• Employer Address
  OK Employer Address is required
• Employer City
  OK Employer City is required
• Employer State
  OK Employer State is required
• Employer Zip Code
  OK Employer Zip Code is required

• Have you had a transaction account at this or another financial intermediary within 12 months before making this application?

  • Yes
  • No
  OK Have you had a transaction account at this or another financial intermediary within 12 months before making this application? is required
• What is the name of that financial institution?
  OK What is the name of that financial institution? is required

• Have you had an account closed by another financial instiution in the last 12 months?

  • Yes
  • No
  OK Have you had an account closed by another financial instiution in the last 12 months? is required

• Have you ever been convicted of a criminal offense for check fraud?

  • Yes
  • No
  OK Have you ever been convicted of a criminal offense for check fraud? is required

Beneficiary Information

• Would you like to add a beneficiary to this account? Please note - All percentage entries must be a whole number, and the total must equal 100%

  • Yes
  • No
  OK Would you like to add a beneficiary to this account? Please note - All percentage entries must be a whole number, and the total must equal 100% is required
• • Beneficiary 1
  Optional OK Beneficiary 1 is required
• Beneficiary Name
  OK Beneficiary Name is required
• Relation
  OK Relation is required
• Address
  OK Address is required
• Social Security Number
  OK Social Security Number is required
• Date of Birth
  OK Date of Birth is required
• Percentage
  OK Percentage is required
• • Beneficiary 2
  Optional OK Beneficiary 2 is required
• Beneficiary Name
  OK Beneficiary Name is required
• Relation
  OK Relation is required
• Address
  OK Address is required
• Social Security Number
  OK Social Security Number is required
• Date of Birth
  OK Date of Birth is required
• Percentage
  OK Percentage is required
• • Beneficiary 3
  Optional OK Beneficiary 3 is required
• Beneficiary Name
  OK Beneficiary Name is required
• Relation
  OK Relation is required
• Address
  OK Address is required
• Social Security Number
  OK Social Security Number is required
• Date of Birth
  OK Date of Birth is required
• Percentage
  OK Percentage is required
• • Beneficiary 4
  Optional OK Beneficiary 4 is required
• Beneficiary Name
  OK Beneficiary Name is required
• Relation
  OK Relation is required
• Address
  OK Address is required
• Social Securty Number
  OK Social Securty Number is required
• Date of Birth
  OK Date of Birth is required
• Percentage
  OK Percentage is required
• • Beneficiary 5
  Optional OK Beneficiary 5 is required
• Beneficiary Name
  OK Beneficiary Name is required
• Relation
  OK Relation is required
• Address
  OK Address is required
• Social Security Number
  OK Social Security Number is required
• Date of Birth
  OK Date of Birth is required
• Percentage
  OK Percentage is required
• • Beneficiary 6
  Optional OK Beneficiary 6 is required
• Beneficiary Name
  OK Beneficiary Name is required
• Relation
  OK Relation is required
• Address
  OK Address is required
• Social Security Number
  OK Social Security Number is required
• Date of Birth
  OK Date of Birth is required
• Percentage
  OK Percentage is required
• • Beneficiary 7
  Optional OK Beneficiary 7 is required
• Beneficiary Name
  OK Beneficiary Name is required
• Relation
  OK Relation is required
• Address
  OK Address is required
• Social Security Number
  OK Social Security Number is required
• Date of Birth
  OK Date of Birth is required
• Percentage
  OK Percentage is required
• • Beneficiary 8
  Optional OK Beneficiary 8 is required
• Beneficiary Name
  OK Beneficiary Name is required
• Relation
  OK Relation is required
• Address
  OK Address is required
• Social Security Number
  OK Social Security Number is required
• Date of Birth
  OK Date of Birth is required
• Percentage
  OK Percentage is required

Please Contact Home State Bank directly after you have submitted your application to add more then 8 beneficiaries.

Joint Applicant

• Will this be a joint account?

  • No, I am the only applicant
  • Yes, I have a co-applicant
  OK Will this be a joint account? is required

Co-Applicant Basic Info

• First Name
  OK First Name is required
• Last Name
  OK Last Name is required
• Email
  OK Email is required
• Phone
  OK Phone is required
• Date of Birth
  OK Date of Birth is required
• Social Security Number
  OK Social Security Number is required

Co-Applicant Address

• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip Code
  OK Zip Code is required
• • Mailing address is different
  Optional OK Mailing address is different is required

Co-Applicant Mailing Address

• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip Code
  OK Zip Code is required

Co-Applicant Previous Address

• Have you lived at this address for less than 2 years?

  • No
  • Yes
  OK You must select one of the following.
• Previous Address
  OK Previous Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip Code
  OK Zip Code is required

Co-Applicant Identification

• What form of ID would you prefer to use?

  • Drivers license or state-issued ID
  • US Passport
  OK What form of ID would you prefer to use? is required
• License Number
  OK License Number is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Issued Date
  OK Issued Date is required
• Expiration Date
  OK Expiration Date is required
• Passport Number
  OK Passport Number is required
• Expiration Date
  OK Expiration Date is required

Co-Applicant Tax Status

• • 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.
  • 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.
  OK Please select one of the following.

What is this?

If you have any questions about how to complete this section please download instructions.

Co-Applicant Additional Information

• Work Phone
  OK Work Phone is required
• Cell Phone
  OK Cell Phone is required
• Occupation
  OK Occupation is required
• Employer
  OK Employer is required
• Employer Address
  OK Employer Address is required
• Employer City
  OK Employer City is required
• Employer State
  OK Employer State is required
• Employer Zip Code
  OK Employer Zip Code is required

• Have you had a transaction account at this or another financial intermediary within 12 months before making this application?

  • Yes
  • No
  OK Have you had a transaction account at this or another financial intermediary within 12 months before making this application? is required
• What is the name of that financial institution?
  OK What is the name of that financial institution? is required

• Have you had an account closed by another financial institution in the last 12 months?

  • Yes
  • No
  OK Have you had an account closed by another financial institution in the last 12 months? is required

• Have you ever been convicted of a criminal offence for check fraud?

  • Yes
  • No
  OK Have you ever been convicted of a criminal offence for check fraud? is required

Important Information About Procedures for Opening a New Account:

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

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