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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Club Account

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.

Business Information

  • OK Business Name is required
  • OK Business Type is required
  • OK Contact Name is required
  • OK Permanent 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
  • Business Phone

    - -
    OK Business Phone is required
  • Business Fax

    - -
    Optional OK Business Fax is required
  • Business Cell Phone

    - -
    Optional OK Business Cell Phone is required
  • OK Tax ID Number is required
  • OK E-mail is required

Contact Information

  • Optional OK Choose the location you would like to complete your application: is required
  • How would you prefer to be contacted?

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

    Optional OK When is the best time to arrange an appointment? 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.