Personal Checking/Savings Account Application EZ150
Submitter Information
First Name (required)
Last Name (required)
Resolve the errors marked in red before submitting again.
First NameMiddle InitialLast Name

 
Address Information
Date of BirthSocial Security No.Inquiry Code

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

 
Home PhoneWork PhoneCell PhoneEmployerOccupation

 
Email Address
First NameMiddle InitialLast Name

 
Address Information
Date of BirthSocial Security No.Inquiry Code

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

 
Home PhoneWork PhoneCell PhoneEmployerOccupation

 
Email Address
(required)
In Trust For
NameSocial Security No.

 
Custodial
NameSocial Security No.

 
Payable on Death
Beneficiary Name(s)

 
Checking Accounts
Savings Accounts
Money Market Accounts
FNB Debit Card