Applied Bank - Account Maintenance Request

Customer Information

First Name

Last Name

SSN Last 4

Account Number Last 4

Request Information

Additional Details

Upload Supporting Documents

Please upload the following documents to support your request. If you are on a mobile device, you can easily take an image of the documents and upload.

Proof of address/phone verification item (ex. utility bill, phone bill, bank statement, tax form)
Upload file must not be greater than 5 Megabytes and must be in a PDF, JPG, JPEG or PNG format

Driver's License or Government Issued ID

Electronic Consent

By clicking on the "Submit Your Request" button below, I authorize Applied Bank to honor my request as indicated on this request form and represent to Applied Bank that all information given in this request is true, correct, and complete. I acknowledge that upon submission of the request form, Applied Bank will contact me to verify the request and no changes will be made to my account until such verification is complete. I further authorize Applied Bank to obtain any other information it believes is necessary to (i) complete this request, or (ii) provide any services Applied Bank extends to me as a result of this request. I acknowledge and agree that the Applied Bank Deposit Agreement and Terms and Conditions, as they both may be amended from time to time, govern my account including this submission.

You can submit requests to update or close your account, manage or re-order your debit card, re-order checks, or receive a copy of a check or statement.

Customer Information

Account Maintenance Request

Request Information

Upload Supporting Documents

Electronic Consent