Checking & Savings Account Application

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 for other information that will allow us to identify you. We will also ask to see your driver's license or other identifying documents.

Opening Deposit Requirement: $100.00*
*non-applicable for Freedom Savings Accounts

Account Type *
Ownership *
Single Owner (Individual) Joint (with right to survivorship) Joint (with no right to survivorship)

Primary Account Holder Information

First Name *
Middle Initial
Last Name *
Social Security Number *
Date of Birth *
Street Address *
P.O. Box
City *
State *
Zip *
Home Phone *
Cell Phone
Work Phone
Email *
Mother's Maiden Name
Employer
Occupation

Joint Account Holder Information

First Name *
Middle Initial
Last Name *
Social Security Number *
Date of Birth *
Street Address *
P.O. Box
City *
State *
Zip *
Home Phone *
Cell Phone
Work Phone
Email *
Mother's Maiden Name
Employer
Occupation

By typing my name below, I certify that all information provided by me is true, correct, and complete. I authorize Fowler State Bank to make whatever inquiries about me they deem necessary and appropriate for the purpose of evaluating my deposit application, including ChexSystems reports, a Specialty Consumer Reporting Agency.

Agreement/Signature *
Joint Applicant Signature *
Bank Representative