Account Opening Form

Name*

First Name

Middle Name

Last Name

Date of Birth (joint owner)*

Month

Day

Year

Social Security Number (joint owner)*

Telephone Number (joint owner)*

E-mail (joint owner)*

[email protected]

Physical Address (joint owner)*

Street Address

Street Address Line 2

City

State

Zip Code

If joint owner physical address is different than mailing address.

Select if different.

Mailing Address (joint owner)*

Street Address

Street Address Line 2

City

State

Zip Code

Are you currently a resident of Oklahoma? (joint owner)*

Yes

Have you lived at this address for less than 2 years? (joint owner) *

Yes

What form of ID would you prefer to use? (joint owner) *

Driver's license

State-issued ID

US Passport

ID number*

State Issued*

Issue Date*(MM/DD/YYYY)

Expiration date of ID*(MM/DD/YYYY)

ID number*

State Issued*

Issue Date*(MM/DD/YYYY)

Expiration date of ID*(MM/DD/YYYY)

ID number*

State Issued*

Issue Date*(MM/DD/YYYY)

Expiration date of ID*(MM/DD/YYYY)

Current Employer (joint owner. If retired, please list company retired from)*

Occupation Type (joint owner)*

Authorization*

I/We certify the accuracy of the above information and authorize The First National Bank and Trust Co Chickasha (FNBT) to access information to authenticate our identity(s) and facilitate the processing of this application for an FNBT account only. I/We understand that we may ask questions based on the information submitted as part of this process. I/We also understand that FNBT may review our credit history and past banking relationships before accepting this application.

Account Opening Form

Personal Information

Important Information About Procedures for Opening a New Account:

Account Opening Form

Personal Information

Joint Owner Personal Information

Important Information About Procedures for Opening a New Account: