PIONEER BANK ONLINE APPLICATION
You will need to print this and mail it to:
P.O. Box 1360· 125 E Colorado Blvd Ste 1A· Spearfish· South Dakota · 57783

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  LAST NAME                                     FIRST                              MI           SOCIAL SECURITY NO.                HOME PHONE                  BUS PHONE

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ADDRESS                                                                  CITY                                             STATE                       ZIP                          E MAIL ADDRESS

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ACCOUNTS TO INCLUDE IN THIS AGREEMENT (check one box)

q  INCLUDE ALL ACCOUNTS WHERE I AM THE FIRST OWNER LISTED ON THE ACCOUNT, INCLUDING ANY ACCOUNTS THAT I MAY OPEN IN THE FUTURE, AND ANY ACCOUNTS LISTED BELOW WHERE I AM AN AUTHORIZED SIGNER BUT NOT THE FIRST OWNER LISTED ON THE ACCOUNT.
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q INCLUDE ONLY ACCOUNTS LISTED ON THIS AGREEMENT. I UNDERSTAND THAT ANY ACCOUNTS OPENED AFTER THIS AGREEMENT WILL NOT BE ACCESSABLE THRU PIONEER BANK ONLINE WITHOUT ME SPECIFICALLY REQUESTING THE ACCOUNT TO BE ADDED TO PIONEER BANK ONLINE.

ENTER THE ACCOUNT NUMBER IN THE FIRST COLUMN. LIST THE TYPE OF ACCOUNT (checking, savings, loan, certificate, or IRA) IN THE SECOND COLUMN.  LIST THE DESCRIPTIVE NAME YOU WOULD LIKE TO USE FOR EACH ACCOUNT YOU HAVE SELECTED IN THE THIRD COLUMN.   WE WILL NOT PASS ANY OF YOUR ACCOUNT NUMBERS OVER THE INTERNET, AND OUR EMPLOYEES WILL NOT ASK YOU FOR ANY ACCOUNT NUMBERS OVER THE INTERNET. (Examples of some account descriptions you might like to use: CHECKING, SAVINGS, TRUCK LOAN, HOME LOAN, etc.)  NO MORE THAN 20 CHARACTERS CAN BE USED INCLUDING BLANKS.  DO NOT REPEAT ACCOUNT DESCRIPTIONS OR USE SPECIAL CHARACTERS.

ACCOUNT NUMBER          ACCOUNT TYPE      DESCRIPTIVE NAME

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FOR BANK USE:
  
APPROVED BY:__________________ DATE___________________ ID#_______________________________________ CIF#_____________
PLEASE READ BEFORE SIGNING
I certify that the information provided is true and correct. I authorize Pioneer Bank & Trust to verify any information included in this application and allow access to all the accounts I am an authorized signer on and listed above. The use of PIONEER BANK ONLINE shall be governed by the printed terms and conditions of the PIONEER BANK ONLINE AGREEMENT AND DISCLOSURES and such other terms and conditions or amendments thereto, as may be established by Pioneer Bank & Trust when they are communicated to me in writing.

The Undersigned agrees to the terms stated above and in the PIONEER BANK ONLINE AGREEMENT AND DISCLOSURES.
  
Signature ________________________________________Date _____________________