Personal Checking/Savings Account Application
Submitter Information (Required)
First Name
(required)
Last Name
(required)
Resolve the errors marked in red before submitting again.

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

Account Holders must reside in Kansas.

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 on-line 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 on-line and click "Submit Application" or fax it to 785.825.7663. Alternatively, you can print the completed application and bring it to a First Bank Kansas location.
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
(required)
Primary Account Holder Information
First NameMiddle Last Name

 
Date of BirthSocial Security No.Home Phone

 
Email AddressMother's Maiden Name

 
Driver's License No.Driver's License StateDriver's License Issue DateDriver's License Expiration Date

 
Street AddressCityStateZip

 
EmployerOccupationWork Phone

 
Joint Account Holder (with rights of survivorship)
First NameMiddle Last Name

 
Date of BirthSocial Security No.

 
Home PhoneEmail AddressMother's Maiden Name

 
Driver's License No.Driver's License StateDriver's License Issue DateDriver's License Expiration Date

 
Street AddressCityStateZip

 
EmployerOccupationWork Phone

 
Payable on Death Beneficiary (if you selected POD/Beneficiary ownership)
First NameMiddleLast Name

 
Social Security No.Home Phone

 
Street AddressCityStateZip

 
I/We would like to apply for the following account(s):
Checking Accounts
Savings Accounts
Money Market Accounts
Mastercard Debit Card
Number of Mastercard Debit Cards
Which First Bank Kansas location do you prefer to use?

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 Mastercard Debit card(s) listed above. 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 governed by this application, all persons listed here will be owners. 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