Please fill out the fields in the form to the right. One of our representatives will contact you within one business day to complete the process.

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Certificates of Deposit (CDs)

Your time is valuable! This application is intended to expedite the account opening process.

For most accounts and services, submission of this online application will not replace the necessity for you to personally visit one of our convenient locations to complete the process. This will likely include:

  • Obtaining any additional information needed
  • Obtaining your signature on necessary account agreements/documents
  • Verification of identification
  • Receipt of appropriate regulatory disclosures, etc.

After submitting this online application, you should expect a representative from the bank to contact you via e-mail or phone within two business days to schedule an appointment for completion of the process. Should you have any questions, do not hesitate to contact us at webadmin@fsb4me.com or call us direct at 937-695-0331.

Personal Information

  • Are you a new customer?

    OK Are you a new customer? is required
  • OK Name is required
  • Social Security Number

    - -
    OK Social Security Number is required
  • Date of Birth

    OK Date of Birth is required
  • Home Phone

    - -
    OK Home Phone is required
  • Daytime Phone

    - -
    Optional OK Daytime Phone is required
  • OK Mother's Maiden Name is required
  • OK Email is required

Contact Information

  • Optional OK Choose the location you would like to complete your application is required
  • When is the best time to contact you?

    Optional OK When is the best time to contact you? is required
  • How would you prefer to be contacted?

    Optional OK How would you prefer to be contacted? is required

Address Information

  • OK Residential Address (Not a P.O. Box) is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • Use residential address for mailing address

    OK Use residential address for mailing address is required
  • OK Mailing Address (if different than above) is required
  • OK City is required
  • OK State is required
  • OK Zip is required

Joint Account Information

  • Number of Joint Owners on this Account

    OK Number of Joint Owners on this Account is required

Joint Applicant #1

  • OK Relationship to Primary Applicant is required
  • OK Name is required
  • Date of Birth

    OK Date of Birth is required
  • Social Security Number

    - -
    OK Social Security Number is required
  • Home Phone

    - -
    OK Home Phone is required
  • OK Residential Address is required
  • OK City is required
  • OK State is required
  • OK Zip is required

Joint Applicant #2

  • OK Relationship to Primary Applicant is required
  • OK Name is required
  • Date of Birth

    OK Date of Birth is required
  • Social Security Number

    - -
    OK Social Security Number is required
  • Home Phone

    - -
    OK Home Phone is required
  • OK Residential Address is required
  • OK City is required
  • OK State is required
  • OK Zip is required

Comments

  • Optional OK is required

Security Code

  • OK is required
  • First State Bank 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, you grant full permission to do so.