Personal Information
Identity Verification
Opening Deposit

Personal Information

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Personal Information
Identity Verification
Opening Deposit

Secure Form

This form supports TLS 1.2 encryption to protect your personal information while it is in transit.

To learn more about what we do with personal information, view our Privacy Policy

Applicant Information

U.S. Citizenship Requirement

You must be a U.S. citizen in order to apply online for an account with Grant County Bank. If you are not a U.S. citizen, please visit one of our branch offices to open an account.

- By checking this box, I confirm I am a U.S. citizen.
OK By checking this box, I confirm I am a U.S. citizen. is required

Eligibility

Grant County Bank of Ulysses, Kansas, is currently only accepting online applications from residents in the states of Kansas, Oklahoma, Texas and Colorado. Before proceeding, please confirm your eligibility below:

OK Please indicate your state of residency: is required

Please indicate your state of residency:
- Kansas
- Oklahoma
- Texas
- Colorado
- By checking this box, I confirm that I am a resident in the eligible state indicated above.
OK By checking this box, I confirm that I am a resident in the eligible state indicated above. is required

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
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
OK State is required
Zip Code
OK Zip Code is required

Previous Address

OK You must select one of the following.

Have you lived at this address for less than 2 years?
- No
- Yes
Previous Address
OK Previous Address is required
City
OK City is required
State
OK State is required
Zip Code
OK Zip Code is required

Identification

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

What form of ID would you prefer to use?
- Drivers license or state-issued ID
- US Passport
License Number
OK License Number is required
State
OK State is required
Issue Date
OK Issue 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

OK Please select one of the following.
- 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 due to failure to report interest and dividend income, 3. I am a U.S. person, and 4. I am exempt from FATCA reporting.
- I am subject to backup withholding. You will know if this applies to you.

What is this?

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

Joint Applicant

OK Will this be a joint account? is required

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

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
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
OK State is required
Zip Code
OK Zip Code is required

Co-Applicant Previous Address

OK You must select one of the following.

Have you lived at this address for less than 2 years?
- No
- Yes
Previous Address
OK Previous Address is required
City
OK City is required
State
OK State is required
Zip Code
OK Zip Code is required

Co-Applicant Identification

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

What form of ID would you prefer to use?
- Drivers license or state-issued ID
- US Passport
License Number
OK License Number is required
State
OK State is required
Issue Date
OK Issue 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

OK Please select one of the following.
- 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 due to failure to report interest and dividend income, 3. I am a U.S. person, and 4. I am exempt from FATCA reporting.
- I am subject to backup withholding. You will know if this applies to you.

What is this?

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

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.

Personal Information

5 Year CD

Open Your Account

Secure Form

Confirm Information

Verify

Fund Your Account

Thank You!

Applicant Information

U.S. Citizenship Requirement

Eligibility

Please indicate your state of residency:

Basic Info

Address

Mailing Address

Previous Address

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

Identification

What form of ID would you prefer to use?

Tax Status

Joint Applicant

Will this be a joint account?

Co-Applicant Basic Info

Co-Applicant Address

Co-Applicant Mailing Address

Co-Applicant Previous Address

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

Co-Applicant Identification

What form of ID would you prefer to use?

Co-Applicant Tax Status