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3024 SW Wanamaker Road
Topeka, KS 66614
Call Us: (785) 440-2200

(785) 440-2200

New Account Application

Having already read and accepted the previous account disclosure statements, please complete and submit the secure application form below. A customer service representative will then contact you to arrange a convenient time for you to stop by the bank so we can complete the process. Feel free to contact us if you should have any questions.
New Account Application

* = Required field

Please enter a valid Name
Please enter a valid address
Please enter a valid City.
Please select a state.
Please enter a valid zip code.
Please enter a valid fax number.
Please enter a valid phone number.
Please enter a valid email.
Please enter a valid date.
Please enter a Social Security number in the format NNN-NN-NNNN.
Please enter a valid number.
Please enter a valid date.
Please enter a valid date.
Account(s) Interested In:

Personal Accounts

Personal Accounts

Business Accounts

Business Accounts
Are you currently a customer of the bank?
Are you currently a customer?
Please make a selection.

BY CLICKING 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 HERITAGE 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 FURTHER AGREE TO RETURN ANY ACCESS DEVICE FOR OBTAINING FUNDS FROM ANY TYPE OF ACCOUNT UPON DEMAND BY HERITAGE BANK.