APPLY FOR A MiiX R.O.C.

Please choose an option from the drop-down list.
Legal Name(Required)
MM slash DD slash YYYY
Your Mailing Address(Required)
Subject Property Address(Required)
Work Address
Total Monthly Income from All Sources.
Total Annual Income from All Sources.
Asset Details(Required)
Asset
Value
 
List the Type of Assets You Hold and Enter their Values. Click the "+" to add each one.
What is Your Current Residential Status?(Required)
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Max. file size: 512 MB.
    To ensure the safety of your identity, you can redact portions of your identification. There must be enough information visible to match the signatory executing this form.
    Co-signer's Legal Name (if applicable)
    Co-signer's Current Address
    Total Monthly Income from All Sources.
    Total Annual Income from All Sources.
    I am the legal Signor of this form. Everything that I have stated herein is true and correct. I understand that my information will be stored safely and securely. I authorize verification of my identity and employment. I understand that this information is being used for the purpose(s) indicated above and, as Signor, do hereby authorize submission of this form.
    MM slash DD slash YYYY
    MM slash DD slash YYYY

    NOTICE:  MiiX Bank, N.A. and its related services are not yet available to the general public.  Please check back with us or feel free to Contact Us so we may notify you when these services become available. Thank you for your patience.

    NOTICE:  The MiiX Financial eApplication is currently in testing.  Submissions are not being processed at this time. Please Contact Us to request to be notified when eApplication processing will begin.