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Business New Account Form

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Business Account Information

Welcome to MidSouth Bank's online Business Account application. MidSouth Bank is a community bank serving the consumers and businesses within the state of Louisiana and Texas. Applications originating outside Louisiana or Texas may be denied. Please select the options below and click next to continue.

Required Information:

I am a: New Customer Existing Customer

MidSouth branch nearest to you:


Account Type you are applying for:


Opening Amount:
(Please round to nearest dollar)

Options:

add Cash Management (Online Banking)
add Bill Pay
add Credit Card
add Debit Card

(You must also select Cash Management in order to add Bill Pay)

We recommend you use a web browser that supports 128-bit encryption in order to keep your information secure.

Online Banking

Online Banking disclosure/agreement:



I agree I do not agree

Bill Pay

Bill Pay disclosure/agreement:



I agree I do not agree
Business Information

(all fields are required unless otherwise noted)

Business Name:
Business Type:
Physical Street Address:
Physical Street Address 2: (optional)
Physical Apt or Suite: (optional)
Physical City:
Physical State:
Physical Zip:
Main Phone:
Fax Phone: (optional)
Federal Tax ID Number:
Nature of Business:

Business Mailing Address Information
(all fields are optional)

The business mailing address is the same as the street address

Mailing Address:
Mailing Address 2:
Apt or Suite:
City:
State:
Zip:
Primary Contact Information

(all fields are required unless otherwise noted)

Title:

Name:
Contact Phone:
Email Address:
How many signers will there be?
Authorized Signer 1 Information
Title:
Name:
Street Address:
Street Address 2: (optional)
Apt or Suite: (optional)
City:
State:
Zip:
Years at Current Address:
Email Address:

(all fields are optional)

Authorized Signer 1 mailing address is the same as Authorized Signer 1 street address
Mailing Address:
Mailing Address 2:
Apt or Suite:
City:
State:
Zip:

(all fields are required unless otherwise noted)
Social Security Number:
Home Phone:
Work Phone: (optional)
Employer Name:
Mother's Maiden Name:
Date of Birth: (mm/dd/yyyy)

Driver's License or ID Number:
ID Issuing State:
ID Type:
Driver's License
Other

ID Issued: (mm/dd/yyyy)

ID Expires: (mm/dd/yyyy)
Authorized Signer 2 Information
Title:
First Name:
Mi:
Last Name:
Street Address:
Street Address 2: (optional)
Apt or Suite: (optional)
City:
State:
Zip:
Years at Current Address:
Email Address:

(all fields are optional)

Authorized Signer 2 mailing address is the same as Authorized Signer 2 street address
Mailing Address:
Mailing Address 2:
Apt or Suite:
City:
State:
Zip:

(all fields are required unless otherwise noted)
Social Security Number:
Home Phone:
Work Phone: (optional)
Employer Name:
Mother's Maiden Name:
Date of Birth: (mm/dd/yyyy)

Driver's License or ID Number:
ID Issuing State:
ID Type:
Driver's License
Other

ID Issued: (mm/dd/yyyy)

ID Expires: (mm/dd/yyyy)
Authorized Signer 3 Information
Title:
First Name:
Mi:
Last Name:
Street Address:
Street Address 2: (optional)
Apt or Suite: (optional)
City:
State:
Zip:
Years at Current Address:
Email Address:

(all fields are optional)

Authorized Signer 3 mailing address is the same as Authorized Signer 3 street address
Mailing Address:
Mailing Address 2:
Apt or Suite:
City:
State:
Zip:

(all fields are required unless otherwise noted)
Social Security Number:
Home Phone:
Work Phone: (optional)
Employer Name:
Mother's Maiden Name:
Date of Birth: (mm/dd/yyyy)

Driver's License or ID Number:
ID Issuing State:
ID Type:
Driver's License
Other

ID Issued: (mm/dd/yyyy)

ID Expires: (mm/dd/yyyy)
Authorized Signer 4 Information
Title:
First Name:
Mi:
Last Name:
Street Address:
Street Address 2: (optional)
Apt or Suite: (optional)
City:
State:
Zip:
Years at Current Address:
Email Address:

(all fields are optional)

Authorized Signer 4 mailing address is the same as Authorized Signer 4 street address
Mailing Address:
Mailing Address 2:
Apt or Suite:
City:
State:
Zip:

(all fields are required unless otherwise noted)
Social Security Number:
Home Phone:
Work Phone: (optional)
Employer Name:
Mother's Maiden Name:
Date of Birth: (mm/dd/yyyy)

Driver's License or ID Number:
ID Issuing State:
ID Type:
Driver's License
Other

ID Issued: (mm/dd/yyyy)

ID Expires: (mm/dd/yyyy)
Cash Management Services

Please list the account(s) you would like to have access to
through Cash Management

I want to use the account I am applying
for with Cash Management
If you have any existing accounts you would like to add to
Cash Management, please list them here (optional)
Account Type: Account Number:
If you do not wish to use Bill Pay, then select "None".

None

The checking account I am applying for

Account #

By Submitting this form, you are granting MidSouth Bank permission to verify your credit and employment history. All applications will be verified through ChexSystems. Approved applications will receive the documentation prepared for your signature through the U. S. Mail.