To apply, having already read and accepted the account disclosures, simply complete and submit this application. Midwest Community Bank will begin the process with the information provided.
A representative from Midwest Community Bank may contact you to verify your account application. Feel free to contact us with any questions you may have at 815-235-6137.
* = Required Field
ON THE SUBMIT BUTTON BELOW, I (WE) APPLY FOR THE
DEPOSIT PRODUCTS LISTED ABOVE AND CERTIFY THAT ALL INFORMATION
PROVIDED ABOVE IS CORRECT AND AUTHORIZE YOU TO CHECK MY (OUR)
CREDIT AND VERIFY THE INFORMATION PROVIDED IN THIS APPLICATION.
I (WE) ALSO CERTIFY UNDER PENALTY OF PERJURY THAT THE SOCIAL
SECURITY NUMBER(S) PROVIDED ABOVE IS/ARE CORRECT AND THAT
I AM NOT (WE ARE NOT) SUBJECT TO BACKUP WITHHOLDING UNDER
THE INTERNAL REVENUE CODE. I (WE) UNDERSTAND THAT ADDITIONAL
INFORMATION MAY BE REQUIRED BEFORE A DECISION CAN BE MADE
REGARDING THIS APPLICATION. I (WE) FURTHER UNDERSTAND THAT
APPROVAL BY MIDWEST COMMUNITY BANK FOR ANY OF THE DEPOSIT
PRODUCTS IS CONDITIONED ON MY (OUR) AGREEMENT TO ABIDE BY
ALL TERMS AND CONDITIONS CONTAINED IN THE APPLICABLE DEPOSIT AGREEMENT.
I would like to have my disclosures sent to my mailing address.
I would like to have my disclosures emailed to me.