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First State Bank Southwest
 

New Account Form

To begin, please fill out the fields in the form below. Someone from Customer Service will contact you within one business day to complete the process.
 
This form uses 256 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.
* Required field

Account Type (please select one) *
Are you a new customer *
*Per government regulations (COPA), we cannot open accounts online for children under the age of 18. Please complete the form by filling in the parent’s information and we will contact you for the minor’s information.

Select the account(s) for which you are applying *
Checking Accounts
Savings Accounts
Customer Services

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING AN ACCOUNT—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.

Personal Information
Why do we ask?
 
In order to properly verify your identity, federal law requires we ask for a government- issued identification number, such as your Social Security number. This information is used solely for the identity verification. Your Social Security number will not be used for any other purpose.

Address Information

Mailing Address

Employment Information

JOINT - Personal Information
Why do we ask?
 
In order to properly verify your identity, federal law requires we ask for a government- issued identification number, such as your Social Security number. This information is used solely for the identity verification. Your Social Security number will not be used for any other purpose.
Address Information

Employment Information
How did you heart about us?

Questions/Comments

Disclosures
Have you had a transaction account at this or another financial intermediary within 12 months before making this application? *
Have you had a transaction account closed by a financial intermediary without your consent within 12 months before making this application? *
Have you been convicted of a criminal offense because of the use of a check or other similar item within 24 months of making this application? *

IMPORTANT
Please read the following disclosures before accepting. I/we have read and agree to the terms and conditions shown above and agree to conform to the bylaws and any amendments of the bank. I certify that statements on this application are true and complete.
 
By checking “I accept”, you acknowledge you have read and agree to the Account Agreement.

First State Bank Southwest reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, I/We grant full permission to do so.
 
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