Account Opening Inquiry

Congratulations on taking the first step to opening your new Simmons Bank account(s)! The inquiry form below will help us collect necessary information to expedite your account opening process. Submitting this form will not officially open your new account(s) – there's still some information and identification we'll need to obtain through an in-person visit at a nearby Simmons Bank branch*. A Simmons banker will be in touch soon to schedule your in-person visit and complete your account opening process. If you have any questions, please email support@simmonsbank.com or call 1-866-246-2400.

*Simmons Bank operates in AR, KS, MO, OK, TN and TX. New, non-existing accountholder inquiries are available only in these states, and in-person signature is required for account opening. Restriction does not apply to existing accountholders.

^* Indicates fields are required

SELECT ACCOUNT TYPE(S)

Learn more about each type of account by clicking the account name(s) below. Details will open in a new tab. Navigate back to this tab when ready to complete the form. Once selection is made, check the box(es) of accounts you would like to open.

Checking Accounts: (Select all that apply) ^*

Classic Checking Interest Checking Prosper Checking Simply Checking Affordable Advantage Checking

Savings Accounts: (Select all that apply) ^*

Simply Savings Money Market Savings Certificate of Deposit (CD)

Primary Owner

First Name ^*

Middle Initial

Last Name ^*

Physical Address ^*

Time at this address ^*

City ^*

State ^*

Zip ^*

Previous Address (If less than 2 years above)

Time at this address

City

State

Zip

Mailing Address (if different than above; could be a P.O. Box)

City

State

Zip

Date of Birth ^* Ex. mm/dd/yyyy

Home / Cell # ^* Ex. ###-###-####

Work # ^* Ex. ###-###-####

Email Address ^* Ex. joe@example.com

Do you currently bank with Simmons Bank? Yes No

Employer Information

Place of Employment ^*

Occupation ^*

Employer Address ^*

Employer Phone # ^* Ex. ###-###-####

City ^*

State ^*

Zip ^*

Time at this place of employment ^*

Previous Place of Employment (if less than 2 years above)

Occupation

Employer Address

Employer Phone Ex. ###-###-####

City

State

Zip

Time at this place of employment

POD Beneficiary

Please check one ^* INDIVIDUAL – ON THE DEATH OF THE INDIVIDUAL OWNER, OWNERSHIP PASSES AS PART OF THE INDIVIDUAL OWNER'S ESTATE POD (PAYABLE ON DEATH)

ARE YOU A U.S. CITIZEN OR THE CITIZEN OF A FOREIGN COUNTRY? ^* U.S. Citizen Citizen of a foreign country

Are you a senior foreign political figure? ^* Yes No

Are you a close associate or family member of a senior foreign political figure? ^* Yes No

Would you like to add a joint (secondary) owner? ^* Yes No

SIMMONS BANKER: (IF APPLICABLE, PLEASE PROVIDE THE NAME OF YOUR SIMMONS BANKER SO WE CAN SEND THEM YOUR INQUIRY)

ARE YOU INTERESTED IN ANY OF THE FOLLOWING? PLEASE SELECT ALL THAT APPLY.

Debit Card Checks Internet Banking

^*I ATTEST THAT ALL OF THE INFORMATION PROVIDED ON THIS INQUIRY FORM IS TRUE AND ACCURATE.

^*I CERTIFY THAT I AM 18 YEARS OF AGE OR OLDER.

Section 326 of the USA Patriot Act requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. This federal requirement applies to all new customers. This information is used to assist the United States government in the fight against the funding of terrorism and money-laundering activities. This means when you open an account, we will ask each person for their name, physical address, mailing address, date of birth, and other information that will allow us to identify them. Additionally, FinCEN has adopted what they describe as a “two pronged” approach to beneficial ownership. The ownership prong includes all-natural persons with 25% or more direct or indirect equity interest in a legal entity while the control prong is a single individual with significant managerial responsibility (the Rule says “control, manage or direct”) over the legal entity. We will ask to see each person’s driver’s license and other identifying documents,and copy or record information from each of them.

SIMMONS BANK FUNDS AVAILABILITY POLICY

Our general policy is to allow you to withdraw funds deposited in your account on the first business day after the day we receive your deposit. Funds from electronic direct deposits will be available on the day we receive the deposit. In some cases, we may delay your ability to withdraw funds beyond the first business day. Then the funds will generally be available by the second business day after the day of deposit.

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Account Opening Inquiry

SELECT ACCOUNT TYPE(S)

Primary Owner

Employer Information

POD Beneficiary

Joint (Secondary) Owner

Employer Information

POD Beneficiary

SIMMONS BANK FUNDS AVAILABILITY POLICY