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First Bank Kansas
Personal Checking/Savings
Account Application

Privacy Policy:
Our privacy policy protects the privacy of your personally-identifying information that you provide us online.

Important Information about Procedures for Opening a New Account
Identification Procedures Requirements: 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 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.

Security Notice:
You should ONLY fill out this Application online if you are using a browser with the latest security enhancements. If you don't have the latest version, download a copy now.

Instructions:
1. Complete Application and click "Submit Application" or fax it to 785-825-7663.
2. To safeguard your privacy, QUIT your browser and restart it again after using this form. This form is NOT saved in your computer's memory when you quit your browser.
3. We will contact you with the location of our closest office for you to sign a signature card. You may also be requested to provide photocopies of your Social Security card and Driver's License, or other documentation.

Account Ownership Information
Single Owner (Individual)


Joint (Right of Survivorship)


Payable on Death (POD) / Beneficiary

Primary Joint Account Holder Information
First Name
Middle Initial
Last Name

Date of Birth
Social Security No.

Home Phone
Email Address
Mother's Maiden Name

Driver's License No.
Driver's License State
Driver's License Issue Date
Driver's License Expiration Date

Street Address
City
State
Zip
Employer
Occupation
Work Phone

Joint Account Holder (Right of Survivorship)
First Name
Middle Initial
Last Name

Date of Birth
Social Security No.

Home Phone
Email Address
Mother's Maiden Name

Driver's License No.
Driver's License State
Driver's License Issue Date
Driver's License Expiration Date

Street Address
City
State
Zip
Employer
Occupation
Work Phone

Payable on Death Beneficiary (if you selected POD/Beneficiary ownership)
First Name
Middle Initial
Last Name

Social Security No.
Home Phone
Street Address
City
State
Zip

I/We would like to apply for the following account(s):

Checking Accounts Savings Accounts
Simple Checking Regular Savings
Elite Checking Minor Savings
Select Checking Money Market Accounts
Money Market Savings
Mastercard Check/ATM Card
Mastercard Check Card 1 2 - or - ATM Card - 1 2
Which branch do you prefer to use?
235 S Santa Fe, Salina
1333 West Crawford, Salina
2860 S Ninth, Salina
1500 Aylward, Ellsworth
1301 N Main, McPherson
1410 N Buckeye, Abilene
118 N Main, Lindsborg
1600 E 17th, Hutchinson

The Internal Revenue Service does not require your consent to any provision of this document other than certification required to avoid backup withholding. See Taxpayer Identification Number Certification below.

By submitting this application, I (each person jointly and severally) apply for the account(s) and Check/ATM card(s) listed above and a personal identification number. As an account owner, I am subject to all of its bylaws and rules as amended from time to time. I certify that all information given is correct. I understand and agree that for all accounts for / or, any one of us opens in the future is governed by this application, and all persons listed here will be owners, except as provided as follows: If I wish an account to have (as applicable) fewer, additional, or different owner(s), a completed, signed application for the specific account must be submitted to and accepted by First Bank Kansas.

I agree to the terms and conditions for any accounts or services that I have now or in the future, and as they change from time to time. I agree at any time you may request information from others about my credit or accounts and that you provide to others experience information about me or my accounts with First Bank Kansas.

I/We AGREE with the above statement