Checking & Savings Account Application First Bank & Trust

Important Information About Procedures For Opening A New Account

(PATRIOT ACT) To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.
What this means for you: 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 or other identifying documents.

General

Primary Account Holder

Social Security Number(Required)

Birth Date(Required)

Driver's License Number(Required)

State Issued(Required)

Date of Expiration(Required)

Date Issued(Required)

Home Phone Number(Required)

Work Phone Number(Required)

E-mail Address(Required)

Occupation(Required)

Employer Name(Required)

Joint Account Holder 1

Social Security Number(Required)

Birth Date(Required)

Driver's License Number(Required)

State Issued(Required)

Date of Expiration(Required)

Date Issued(Required)

Home Phone Number(Required)

Work Phone Number(Required)

E-mail Address(Required)

Occupation(Required)

Employer Name(Required)

Ownership 1

Birth Date(Required)

Social Security Number(Required)

Relationship to holder(Required)

Opening Deposit

Deposit Amount(Required)

Would you like to extend Overdraft Privilege? (Covers ATM withdrawals and every day debit card transactions on your personal account)

We will contact you upon account approval to complete the account opening

Certification

Primary Account Holder's Signature(Required)

Date(Required)

Joint Account Holder's Signature(Required)

Date(Required)

Banking Sign In