Smooth Move Kit

Here’s everything you need for an easy transition to State Bank of Belle Plaine.

We look forward to serving you!

We want to make your move to State Bank of Belle Plaine as easy as possible. That’s why we developed this Smooth Move Kit with everything you’ll need to close your existing accounts and transfer your automaticpayments and deposits. You won’t even need to visit your old bank. Simply follow these steps:

Step 1 Open your new accounts at State Bank of Belle Plaine.

Stop in and one of our Personal Bankers will gladly assist you.OR

Complete our account opening application and mail it to us. Please include a copy of your drivers license. Then, stop in and meet with a Personal Banker to open the account(s) that best meet your needs.

When your new account is open, continue with Steps 2 and 3.

Step 2 We’ll help you close your old accounts.

Simply complete the enclosed form - Authorization to Close My Account - and mail it to your old bank. This form gives them all the information they need and saves you the inconvenience of an in-person visit toclose your accounts. Select a closing date at least 45 to 60 days from today, to allow checks you’ve written to clear and automatic deposits/payments to transfer to your new State Bank of Belle Plaine accounts.

Step 3 Change your direct deposits and automatic payments.

Simply complete the enclosed forms, Authorization to Change Direct Deposit and/or Authorization to Change Automatic Payment. Complete a form for each company. Since most people have MANY automatic payments, we’ve included a form to help you summarize your automatic payments and track your progress as you change them to State Bank of Belle Plaine. Attach a voided check from your newState Bank of Belle Plaine account to each authorization form. Mail them as soon as possible, or drop them off and we’ll mail them for you. Let us know if you have any questions or if we can assist you.

Equal Housing Lender Member FDICstatebankbp.com 9/16

Easy Switch Kit

Everything you need for an easy transition to STAR BANKWe want to make your move to Star Bank as easy as possible. That’s why we developed this Easy SwitchKit with everything you’ll need to close your existing accounts and transfer your automatic payments anddeposits. You won’t even need to visit your old bank. Simply follow these steps:

Step 1 Open your new account at Star Bank.Stop in and one of our bankers will gladly assist you.

ORComplete our account opening application and mail it to us with your opening deposit.(When your new account is open, continue with Steps 2 and 3.)

Step 2 We’ll help you close your old accounts.Simply complete the enclosed form, authorization to Close My account and mail it to your old bank.(Or, we can mail it for you.) This form gives them all the information they need and saves you theinconvenience of an in-person visit to close your accounts. (Select a closing date at least 45 days fromtoday, to allow checks you’ve written to clear and automatic deposits/payments to transfer to your newStar Bank account.)

Step 3 Change your direct deposits and automatic payments.Simply complete the enclosed forms, authorization to Change Direct Deposit and/or authorization toChange automatic Payment. Complete a form for each company. Attach a voided check from your newStar Bank account to each authorization form. Mail them as soon as possible, or drop them off and we’llmail them for you.

We look forward to serving you!

The Bank That Cares™

STARBANK

Member FDICEqual Housing Lender

Annandale • Barrett • Bertha • Eagle Bend • Eden Prairie • Elbow Lake • Graceville • Verndale • Wheaton

www.starbank.net8/10

201 W Main St.

Belle Plaine, MN 56011952.873.2296

201 W Main St, Belle Plaine MN 56011 Phone: 952-873-2296 | Fax: 952-873-2877 | E-mail: info@statebankbp.com

New Account ApplicationImportant procedure information for opening a new account as required by the USA PATRIOT ACT:To help the Government combat the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person (individuals and businesses) who opens an account. When you open an account, we will ask you for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your Driver’s License and/or other identifying documents.

I am interested in: Checking Savings Online Banking Certificate of Deposit(s)Credit Card Debit Card eStatements Other (Please specify)

Name: ___ ____________________________________________________ First Middle Last

Address: ______________________________________________________________________ Street Address or PO Box City State Zip

Mailing Address: (If Different) Street Address or PO Box City State Zip

Social Security Number: Date of Birth:

Primary Phone Number: Home Cell Office

Secondary Phone Number: Home Cell Office

E-mail: Mother’s Maiden Name:

Employer: Position:

Employer’s Address: _____________________________________________ Years with Employer: _____ Street City State Zip

I am a US Citizen: Yes No If no, please list your Country of Citizenship:

Have you had a transaction account at this or another financial intermediary within 12 months before making this application? Yes No Name of Institution:

Have you had a transaction account closed by a financial institution without your consent within 12 months of making this application? Yes No Reason:

Have you been convicted of a criminal offense because of the use of a check or other similar items within 24 months of making this application? Yes No

Name of a Relative not living with you: Relationship:

Address of Relative: _____________________________________________________ Phone: Street City/State

Everything I have stated in this application is correct to the best of my knowledge. I understand that I may be guilty of perjury if I made any material misstatements. I also understand that you will retain this application whether or not it is approved. You are authorized to check my credit and employment history.

Applicant Signature Date

Authorization to Change Automatic Payments

To whom it may concern,This letter is to serve as authorization to change the account from which you debit my automaticpayments. Please use my personal information and signature as authorization to fulfill this request.

Name: _______________________________________________________________________________(First) (Middle) (Last)

Address: ________________________________________________________________________Street Address or PO Box City State Zip

Social Security Number: __________________________ Phone Number: _________________________

This is reference of the account I hold with your company:

Company Name: _______________________________________________________________________

Address: ________________________________________________________________________Street Address City State Zip

Account Number with Company (if applicable): _______________________________________________

The Automatic Payment is currently being withdrawn from the following account:

Former Bank Name: ________________________________________________ Checking Savings

Former Bank Routing Number: ___________________ Former Bank Account Number: _______________

Effective immediately please redirect the Automatic Payment from my account with theState Bank of Belle Plaine as follows:

State Bank of Belle Plaine201 W Main St. PO Box 87 Checking SavingsBelle Plaine, MN 56011

Routing Number: ___________________________ Account Number: ____________________________

I have attached a voided check/withdrawal slip to verify the new account information

If you should have any questions regarding this change, please call me at: ________________________Please send me written confirmation of when the change will be effective.

Sincerely,

Signature Date

091903161

Automatic Payments Checklist

Use this form to summarize all of the automatic payments from your current bank account (including automatic payments using your debit card number). Remember to list all frequencies: bi-weekly, monthly, quarterly, annually, etc… It may be helpful to review the last 12 months of your account statements for a complete list. Use the Authorization to Change Automatic Payments form to change each automatic payment or contact the company via phone or their website for their specific instructions. Make sure to keep your old account open long enough to transfer all automatic payments to your NEW account. Please let us know if you have any questions or if we can assist you.

Company Name Frequency Account Number at the Company

Amount Date of Contact

Confirmation of Successful

Transfer

statebankbp.comEqual Housing Lender Member FDIC

Authorization to Change Direct Deposits

To ,This letter is to serve as authorization to have my Direct Deposit transferred to my new account with the State Bank of Belle Plaine. Please use my personal information and signature as authorization to fulfill this request.

Name: _______________________________________________________________________________ First Middle Last

Address: ________________________________________________________________________Street Address or PO Box City State Zip

Social Security Number: __________________________ Phone Number: _________________________

The Direct Deposit is currently being deposited in to the following account:

Former Bank Name: ________________________________________________ Checking Savings

Former Bank Routing Number: ___________________ Former Bank Account Number: _______________

Effective immediately please redirect the Direct Deposit into my account with the State Bank of Belle Plaine as follows:

State Bank of Belle PlaineChecking Savings201 W Main St.

Belle Plaine, MN 56011

Routing Number: ____091903161_____ ___ Account Number: ____________________________

I have attached a voided check/withdrawal slip to verify the new account information

If you should have any questions regarding this change, please call me at: ________________________Please send me written confirmation of when the change will be effective.

Signature Date

Authorization to Change Automatic Payments

To whom it may concern,This letter is to serve as authorization to change the account from which you debit my automaticpayments. Please use my personal information and signature as authorization to fulfill this request.

Name: _______________________________________________________________________________(First) (Middle) (Last)

Address: ________________________________________________________________________Street Address or PO Box City State Zip

Social Security Number: __________________________ Phone Number: _________________________

This is reference of the account I hold with your company:

Company Name: _______________________________________________________________________

Address: ________________________________________________________________________Street Address City State Zip

Account Number with Company (if applicable): _______________________________________________

The Automatic Payment is currently being withdrawn from the following account:

Former Bank Name: ________________________________________________ Checking Savings

Former Bank Routing Number: ___________________ Former Bank Account Number: _______________

Effective immediately please redirect the Automatic Payment from my account with theState Bank of Belle Plaine as follows:

State Bank of Belle Plaine201 W Main St. PO Box 87 Checking SavingsBelle Plaine, MN 56011

Routing Number: ___________________________ Account Number: ____________________________

I have attached a voided check/withdrawal slip to verify the new account information

If you should have any questions regarding this change, please call me at: ________________________Please send me written confirmation of when the change will be effective.

Sincerely,

Signature Date

091903161

Automatic Payments Checklist

Use this form to summarize all of the automatic payments from your current bank account (including automatic payments using your debit card number). Remember to list all frequencies: bi-weekly, monthly, quarterly, annually, etc… It may be helpful to review the last 12 months of your account statements for a complete list. Use the Authorization to Change Automatic Payments form to change each automatic payment or contact the company via phone or their website for their specific instructions. Make sure to keep your old account open long enough to transfer all automatic payments to your NEW account. Please let us know if you have any questions or if we can assist you.

Company Name Frequency Account Number at the Company

Amount Date of Contact

Confirmation of Successful

Transfer

statebankbp.comEqual Housing Lender Member FDIC

Authorization to Change Automatic Payments

To ,This letter is to serve as authorization to change the account from which you debit my automatic payments. Please use my personal information and signature as authorization to fulfill this request.

Name: _______________________________________________________________________________ First Middle Last

Address: ________________________________________________________________________Street Address or PO Box City State Zip

Social Security Number: __________________________ Phone Number: _________________________

This is reference of the account I hold with your company:

Company Name: _______________________________________________________________________

Address: ________________________________________________________________________Street Address City State Zip

Account Number with Company (if applicable): _______________________________________________

The Automatic Payment is currently being withdrawn from the following account:

Former Bank Name: Checking Savings

Former Bank Routing Number: ___________________ Former Bank Account Number: _______________

Effective immediately please redirect the Automatic Payment from my account with the State Bank of Belle Plaine as follows:

State Bank of Belle Plaine201 W Main St. Checking SavingsBelle Plaine, MN 56011

Routing Number: ____091903161_____ ___ Account Number: ____________________________

I have attached a voided check/withdrawal slip to verify the new account information

If you should have any questions regarding this change, please call me at: ________________________Please send me written confirmation of when the change will be effective.

Signature Date

Authorization to Change Automatic Payments

To whom it may concern,This letter is to serve as authorization to change the account from which you debit my automaticpayments. Please use my personal information and signature as authorization to fulfill this request.

Name: _______________________________________________________________________________(First) (Middle) (Last)

Address: ________________________________________________________________________Street Address or PO Box City State Zip

Social Security Number: __________________________ Phone Number: _________________________

This is reference of the account I hold with your company:

Company Name: _______________________________________________________________________

Address: ________________________________________________________________________Street Address City State Zip

Account Number with Company (if applicable): _______________________________________________

The Automatic Payment is currently being withdrawn from the following account:

Former Bank Name: ________________________________________________ Checking Savings

Former Bank Routing Number: ___________________ Former Bank Account Number: _______________

Effective immediately please redirect the Automatic Payment from my account with theState Bank of Belle Plaine as follows:

State Bank of Belle Plaine201 W Main St. PO Box 87 Checking SavingsBelle Plaine, MN 56011

Routing Number: ___________________________ Account Number: ____________________________

I have attached a voided check/withdrawal slip to verify the new account information

If you should have any questions regarding this change, please call me at: ________________________Please send me written confirmation of when the change will be effective.

Sincerely,

Signature Date

091903161

Automatic Payments Checklist

Use this form to summarize all of the automatic payments from your current bank account (including automatic payments using your debit card number). Remember to list all frequencies: bi-weekly, monthly, quarterly, annually, etc… It may be helpful to review the last 12 months of your account statements for a complete list. Use the Authorization to Change Automatic Payments form to change each automatic payment or contact the company via phone or their website for their specific instructions. Make sure to keep your old account open long enough to transfer all automatic payments to your NEW account. Please let us know if you have any questions or if we can assist you.

Company Name Frequency Account Number at the Company

Amount Date of Contact

Confirmation of Successful

Transfer

statebankbp.comEqual Housing Lender Member FDIC

Authorization to Close My Account

To ,

This letter is to serve as authorization to close my account. Please use my personal information and signature as authorization to fulfill this request.

On ___________ please close my account atDate Financial Institution where account is closing

o Close all accounts

o Checking account #:

o Savings account #:

Financial Institution Address:Where account is closing

Name of Account Holder: SSN#:First Middle Last

Second Account Holder: SSN#:First Middle Last

On closing date (see above) please send the remaining funds to:

o STATE BANK OF BELLE PLAINE, 201 W MAIN ST., BELLE PLAINE MN 56011

o Directly to me:Street Address or PO Box City State Zip

Signature Date

Signature Date

Complete this form for each Financial Institution you wish to close accounts.

Authorization to Change Automatic Payments

To whom it may concern,This letter is to serve as authorization to change the account from which you debit my automaticpayments. Please use my personal information and signature as authorization to fulfill this request.

Name: _______________________________________________________________________________(First) (Middle) (Last)

Address: ________________________________________________________________________Street Address or PO Box City State Zip

Social Security Number: __________________________ Phone Number: _________________________

This is reference of the account I hold with your company:

Company Name: _______________________________________________________________________

Address: ________________________________________________________________________Street Address City State Zip

Account Number with Company (if applicable): _______________________________________________

The Automatic Payment is currently being withdrawn from the following account:

Former Bank Name: ________________________________________________ Checking Savings

Former Bank Routing Number: ___________________ Former Bank Account Number: _______________

Effective immediately please redirect the Automatic Payment from my account with theState Bank of Belle Plaine as follows:

State Bank of Belle Plaine201 W Main St. PO Box 87 Checking SavingsBelle Plaine, MN 56011

Routing Number: ___________________________ Account Number: ____________________________

I have attached a voided check/withdrawal slip to verify the new account information

If you should have any questions regarding this change, please call me at: ________________________Please send me written confirmation of when the change will be effective.

Sincerely,

Signature Date

091903161

Automatic Payments Checklist

Use this form to summarize all of the automatic payments from your current bank account (including automatic payments using your debit card number). Remember to list all frequencies: bi-weekly, monthly, quarterly, annually, etc… It may be helpful to review the last 12 months of your account statements for a complete list. Use the Authorization to Change Automatic Payments form to change each automatic payment or contact the company via phone or their website for their specific instructions. Make sure to keep your old account open long enough to transfer all automatic payments to your NEW account. Please let us know if you have any questions or if we can assist you.

Company Name Frequency Account Number at the Company

Amount Date of Contact

Confirmation of Successful

Transfer

statebankbp.comEqual Housing Lender Member FDIC

Authorization to Change Automatic Payments

To whom it may concern,This letter is to serve as authorization to change the account from which you debit my automaticpayments. Please use my personal information and signature as authorization to fulfill this request.

Name: _______________________________________________________________________________(First) (Middle) (Last)

Address: ________________________________________________________________________Street Address or PO Box City State Zip

Social Security Number: __________________________ Phone Number: _________________________

This is reference of the account I hold with your company:

Company Name: _______________________________________________________________________

Address: ________________________________________________________________________Street Address City State Zip

Account Number with Company (if applicable): _______________________________________________

The Automatic Payment is currently being withdrawn from the following account:

Former Bank Name: ________________________________________________ Checking Savings

Former Bank Routing Number: ___________________ Former Bank Account Number: _______________

Effective immediately please redirect the Automatic Payment from my account with theState Bank of Belle Plaine as follows:

State Bank of Belle Plaine201 W Main St. PO Box 87 Checking SavingsBelle Plaine, MN 56011

Routing Number: ___________________________ Account Number: ____________________________

I have attached a voided check/withdrawal slip to verify the new account information

If you should have any questions regarding this change, please call me at: ________________________Please send me written confirmation of when the change will be effective.

Sincerely,

Signature Date

091903161

Automatic Payments Checklist

Use this form to summarize all of the automatic payments from your current bank account (including automatic payments using your debit card number). Remember to list all frequencies: bi-weekly, monthly, quarterly, annually, etc… It may be helpful to review the last 12 months of your account statements for a complete list. Use the Authorization to Change Automatic Payments form to change each automatic payment or contact the company via phone or their website for their specific instructions. Make sure to keep your old account open long enough to transfer all automatic payments to your NEW account. Please let us know if you have any questions or if we can assist you.

Company Name Frequency Account Number at the Company

Amount Date of Contact

Confirmation of Successful

Transfer

statebankbp.comEqual Housing Lender Member FDIC

Authorization to Change Automatic Payments

To whom it may concern,This letter is to serve as authorization to change the account from which you debit my automaticpayments. Please use my personal information and signature as authorization to fulfill this request.

Name: _______________________________________________________________________________(First) (Middle) (Last)

Address: ________________________________________________________________________Street Address or PO Box City State Zip

Social Security Number: __________________________ Phone Number: _________________________

This is reference of the account I hold with your company:

Company Name: _______________________________________________________________________

Address: ________________________________________________________________________Street Address City State Zip

Account Number with Company (if applicable): _______________________________________________

The Automatic Payment is currently being withdrawn from the following account:

Former Bank Name: ________________________________________________ Checking Savings

Former Bank Routing Number: ___________________ Former Bank Account Number: _______________

Effective immediately please redirect the Automatic Payment from my account with theState Bank of Belle Plaine as follows:

State Bank of Belle Plaine201 W Main St. PO Box 87 Checking SavingsBelle Plaine, MN 56011

Routing Number: ___________________________ Account Number: ____________________________

I have attached a voided check/withdrawal slip to verify the new account information

If you should have any questions regarding this change, please call me at: ________________________Please send me written confirmation of when the change will be effective.

Sincerely,

Signature Date

091903161

Automatic Payments Checklist

Use this form to summarize all of the automatic payments from your current bank account (including automatic payments using your debit card number). Remember to list all frequencies: bi-weekly, monthly, quarterly, annually, etc… It may be helpful to review the last 12 months of your account statements for a complete list. Use the Authorization to Change Automatic Payments form to change each automatic payment or contact the company via phone or their website for their specific instructions. Make sure to keep your old account open long enough to transfer all automatic payments to your NEW account. Please let us know if you have any questions or if we can assist you.

Company Name Frequency Account Number at the Company

Amount Date of Contact

Confirmation of Successful

Transfer

statebankbp.comEqual Housing Lender Member FDIC