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Personal Account Form

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Personal Information


Welcome to MidSouth Bank's online 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 Online Banking
add Bill Pay

(You must also select Online Banking 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 disclosure/agreement



I agree I do not agree
Bill Pay disclosure/agreement



I agree I do not agree

Account Type


Please select from one of the options below:

Individual Account
Joint Account
Primary Account Holder Information

(all fields are required unless otherwise noted)

Title:

Name:
Street Address:
Street Address 2: (optional)
Apt or Suite: (optional)
City:
State:
Zip:
Years at Current Address:
Email Address:
Employee of MidSouth Bank?
Please enter your employee number:

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)
I would like an ATM or Check Card
I would like to add a Credit Card

(all fields are optional)
My mailing address is the same as my street address

Mailing Address:
Mailing Address 2:
Apt or Suite:

City:
State:
Zip:
Secondary Account Holder Information

(all fields are required unless otherwise noted)

Title:
Name:
Street Address:
Street Address 2: (optional)
Apt or Suite: (optional)
City:
State:
Zip:
Years at Current Address:
Email Address:
Employee of MidSouth Bank?
Please enter your employee number:

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)
I would like an ATM or Check Card
I would like to add a Credit Card

(all fields are optional)
My mailing address is the same as my street address

Mailing Address:
Mailing Address 2:
Apt or Suite:
City:
State:
Zip:
Online Banking

Please list the account(s) you would like to have access to
through Online Banking

I want to use the account I am applying
for with Online Banking

If you have not specified any checking accounts for use with
Online Banking, or you do not wish to use Bill Pay, then select "None".

None

The checking account I am applying for

By submitting this form, you are granting MidSouth Bank permission to verify your credit and employment history. All applications will be verified through Equifax. Approved applications will receive a phone call to schedule document and signature card signing.