New Account :: Farmers State Bank of Quinton, Oklahoma

Date

Thank you for your interest in opening an account with Farmers State Bank!

Before you complete this application, please be aware that regulations require us to obtain two forms of identification from you prior to opening your account. One of the forms must be a picture ID - for example, a Driver's License, State-Issued Card or Passport.

In addition, the address that you wish to use on your new account must correspond to the address indicated on your picture ID. If it does not match, there are a couple of options available to you.

1. You can obtain a new picture ID that has the correct address on it; or
2. You can provide us with the utility bill in your name indicating an address that corresponds to what you wish to use on your account.

We hope that these requirements do not cause you any inconvenience. We appreciate the opportunity to earn your business!

Please tell us about yourself:

First Name *

Middle Name

Last Name *

Social Security Number *

Date of Birth *

Driver's License Number *

State of Issuance *

Issue Date *

Expiration Date *

Current Address *

City *

State *

Zip Code *

Employed By *

How long have you been employed there? *

Primary Phone Number*

Other Phone Number

Email Address *

Is this a Joint Account?
No Yes

If this is a Joint Account, please tell us about the second account owner: