Personal Checking Account Application

To begin, please fill out the fields in the form below. One of our representatives will contact you within one business day to complete the process.

This form uses 128 bit SSL encryption, ensuring that no one else will see your personal information while it is in transit. Please view our Privacy Policy for more information.

Are you a new customer? Yes No

Please select a branch.

You must be at least 18 years of age to open an account. Application information will be verified using ChexSystems, a consumer reporting agency. Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means to you: When you open an account, we will ask your name, address, date of birth, and other information that allows us to identify you. We may also ask to see your driver’s license or other identifying documents. You are required to come into a First State Bank location to sign the paperwork.

I agree to the terms and conditions. Please agree to continue.

Personal Information

Name (Last, First, M.I.)	Your name is required.
Social Security Number	Your social security number is required.
Date of Birth (MM/DD/YYYY)	Your date of birth is required.Invalid format.
Home Phone	Your phone number is required.
Daytime Phone
Driver's License or State ID Number	Your driver's license is required.
State of Driver's License (if applicable)	Please select your state.Please select an item.
Email	An email address is required.Invalid format.
Required information bolded

Address Information

Residential Address (Not a P.O. Box)	Your residential address is required.
City	Your city is required.
State	Please select a residential state.
Zip	A zip code (residential address) is required.

Mailing Address (if different than above)
City
State
Zip
Required information bolded

Number of joint owners on this account: 0 1 2

Joint Applicant #1:

Name
Social Security Number
Date of Birth (MM/DD/YYYY)
Drivers License Number
State License Issued
Home Phone
Daytime Phone
Residential Address
City
State
Zip
Email

Joint Applicant #2:

Name
Social Security Number
Date of Birth (MM/DD/YYYY)
Driver's License Number
State License Issued
Home Phone
Daytime Phone
Residential Address
City
State
Zip
Email

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