APPLICATION
FORM |
|
|
Customer
Name _________________________________________ Address
_______________________________________________ City,
State, ZIP__________________________________________ Phone
_________________________________ Social
Security____________________________________ Mother’s
Maiden Name ___________________________________ E-mail
address ____________________________________________________ I
would like the following accounts accessible through FSB Online Banking. Account #
_____________________________
Account #
_____________________________
Account #
_____________________________
Account #
_____________________________
Account #
_____________________________
Account #
_____________________________
Account #
_____________________________
PLEASE READ THE FOLLOWING AND SIGN BELOW.I certify that the information provided above is true and correct.I authorize Farmers State Bank to verify any information on this form. I understand that I will have access to only the accounts listed above and any account that I open in the future will not be accessible unless I notify Farmers State Bank. The undersigned agrees to the terms stated above. Account
Holder Signature______________________________________ Date_________________ Joint
Account Holder Signature__________________________________ Date_________________ |
