Checking & Savings Account Application Important Information About Procedures For Opening A New Account: (PATRIOT ACT) 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 you for your name, address, date of birth, and for other information that will allow us to identify you. We will also ask to see your driver's license or other identifying documents. Opening Deposit Requirement: $100.00* *non-applicable for Freedom Savings Accounts Account Type * Basic Checking Select Checking Savings Freedom Savings Ownership * Single Owner (Individual) Joint (with right to survivorship) Joint (with no right to survivorship) Primary Account Holder Information First Name * Middle Initial Last Name * Social Security Number * Date of Birth * Street Address * P.O. Box City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Home Phone * Cell Phone Work Phone Email * Mother's Maiden Name Employer Occupation By typing my name below, I certify that all information provided by me is true, correct, and complete. I authorize Fowler State Bank to make whatever inquiries about me they deem necessary and appropriate for the purpose of evaluating my deposit application, including ChexSystems reports, a Specialty Consumer Reporting Agency. Agreement/Signature * Bank Representative Quick Links Electronic Document Distribution Agreement About Us Checking Product Education Center Privacy Policy • Interest Rates • Calculators • Annual Report Get in touch Main Office Fowler: 765.884.1200 or 800.439.3951 Fowler Grant Avenue: 765.884.3241 Kentland: 219.474.5444 or 800.207.3615 Williamsport: 765.762.5504 or 800.439.2802 Newsletter Registration Reorder Checks Contact Us View Site Map Connect With Us