Applicant Information

Eligibility

First State Bank is only accepting applications from those who live in the State of Oklahoma.

• • By checking this box, I certify that I live in the State of Oklahoma.
  OK By checking this box, I certify that I live in the State of Oklahoma. is required

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• Enter code
  OK Error - Please enter the code to verify that you can view the required Portable Document Format (PDF) files. If the code isn't visible you will need to visit your nearest branch to apply for an account.

Basic Info

• First Name
  OK First Name is required
• Last Name
  OK Last Name is required
• Email Address
  OK Email Address is required
• Phone
  OK Phone is required
• Date of Birth
  OK Date of Birth is required
• Social Security Number
  OK Social Security Number is required

Address

• Address
  OK Address is required
• City
  OK City is required
• AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming State
  OK State is required
• Zip Code
  OK Zip Code is required
• • Mailing address is different (Optional)
  OK Mailing address is different (Optional) is required

Mailing Address

• Address
  OK Address is required
• City
  OK City is required
• AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming State
  OK State is required
• Zip Code
  OK Zip Code is required

Previous Address

• OK You must select one of the following.

  Have you lived at this address for less than 2 years?

  • No
  • Yes
• Previous Address
  OK Previous Address is required
• City
  OK City is required
• AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming State
  OK State is required
• Zip Code
  OK Zip Code is required

Identification

• OK What form of ID would you prefer to use? is required

  What form of ID would you prefer to use?

  • Drivers license or state-issued ID
  • US Passport
• License Number
  OK License Number is required
• AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming State
  OK State is required
• Expiration Date
  OK Expiration Date is required
• Passport Number
  OK Passport Number is required
• Expiration Date
  OK Expiration Date is required

Tax Status

• OK Please select one of the following.
  • I am not subject to backup withholding. This is most common. Under penalties of perjury, I certify that 1. My Social Security number is correct, 2. I am not subject to backup withholding because (a) I am exempt from backup withholding, (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, 3. I am a U.S. citizen or U.S. resident alien, and 4. I am exempt from FATCA reporting.
  • I am subject to backup withholding. You will know if this applies to you. Under penalties of perjury, I certify that 1. My Social Security number is correct, 2. I am subject to backup withholding because I have been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, 3. I am a U.S. person or U.S. resident alien, and 4. I am exempt from FATCA reporting.

What is this?

If you have any questions about how to complete this section please download instructions.

Additional Information

• OK Are you a US Citizen? is required

  Are you a US Citizen?

  • Yes
  • No
• How long have you lived in the US?
  OK How long have you lived in the US? is required
• OK Do you have permission to work in the US? is required

  Do you have permission to work in the US?

  • Yes
  • No
• OK Are you, or any of your relatives, connected to the government of a country other than the US? is required

  Are you, or any of your relatives, connected to the government of a country other than the US?

  • Yes
  • No
• Please explain.
  OK Please explain. is required
• Place of employment
  OK Place of employment is required
• Occupation
  OK Occupation is required
• OK Do you have any accounts at other financial institutions? is required

  Do you have any accounts at other financial institutions?

  • Yes
  • No
• Where?
  OK Where? is required
• What is the purpose of this account?
  OK What is the purpose of this account? is required
• What is the anticipated average balanc of the account?
  OK What is the anticipated average balanc of the account? is required
• OK Will any proceeds from business activities be deposited ino this account? is required

  Will any proceeds from business activities be deposited ino this account?

  • Yes
  • No
• Type of business
  OK Type of business is required
• Percentage of total deposits
  OK Percentage of total deposits is required
• OK What type of items do you expect to be deposited into the account? Check all that apply. is required

  What type of items do you expect to be deposited into the account? Check all that apply.

  • Cash
  • Direct Deposit
  • Checks
  • Wires
• Frequency of Cash Deposit
  OK Frequency of Cash Deposit is required
• Average Cash Deposit
  OK Average Cash Deposit is required
• Frequency of Direct Deposit
  OK Frequency of Direct Deposit is required
• Average Direct Deposit
  OK Average Direct Deposit is required
• Frequency of Checks Deposit
  OK Frequency of Checks Deposit is required
• Average Checks Deposit
  OK Average Checks Deposit is required
• Frequency of Wire Deposit
  OK Frequency of Wire Deposit is required
• Average Wire Deposit
  OK Average Wire Deposit is required
• OK What method will be used to remove funds from the account? Check all the apply. is required

  What method will be used to remove funds from the account? Check all the apply.

  • Checks
  • ATM/Debit Cards
  • Automated Payments
  • Wires
• Frequency of Wires
  OK Frequency of Wires is required
• Average amount of Wires
  OK Average amount of Wires is required
• OK Will any financial transaction affecting the account originate from or have a destination outside of the US? is required

  Will any financial transaction affecting the account originate from or have a destination outside of the US?

  • Yes
  • No
• Please explain
  OK Please explain is required
• OK Will any of your income come from the sell or distribution of marijuana? is required

  Will any of your income come from the sell or distribution of marijuana?

  • Yes
  • No

Joint Applicant

• OK Will this be a joint account? is required

  Will this be a joint account?

  • No, I am the only applicant
  • Yes, I have a co-applicant

Co-Applicant Basic Info

• First Name
  OK First Name is required
• Last Name
  OK Last Name is required
• Email
  OK Email is required
• Phone
  OK Phone is required
• Date of Birth
  OK Date of Birth is required
• Social Security Number
  OK Social Security Number is required

Co-Applicant Address

• Address
  OK Address is required
• City
  OK City is required
• AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming State
  OK State is required
• Zip Code
  OK Zip Code is required
• • Mailing address is different
  Optional OK Mailing address is different is required

Co-Applicant Mailing Address

• Address
  OK Address is required
• City
  OK City is required
• AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming State
  OK State is required
• Zip Code
  OK Zip Code is required

Co-Applicant Previous Address

• OK You must select one of the following.

  Have you lived at this address for less than 2 years?

  • No
  • Yes
• Previous Address
  OK Previous Address is required
• City
  OK City is required
• AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming State
  OK State is required
• Zip Code
  OK Zip Code is required

Co-Applicant Identification

• OK What form of ID would you prefer to use? is required

  What form of ID would you prefer to use?

  • Drivers license or state-issued ID
  • US Passport
• License Number
  OK License Number is required
• AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming State
  OK State is required
• Expiration Date
  OK Expiration Date is required
• Passport Number
  OK Passport Number is required
• Expiration Date
  OK Expiration Date is required

Co-Applicant Tax Status

• OK Please select one of the following.
  • I am not subject to backup withholding. This is most common. Under penalties of perjury, I certify that 1. My Social Security number is correct, 2. I am not subject to backup withholding because (a) I am exempt from backup withholding, (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, 3. I am a U.S. citizen or U.S. resident alien, and 4. I am exempt from FATCA reporting.
  • I am subject to backup withholding. You will know if this applies to you. Under penalties of perjury, I certify that 1. My Social Security number is correct, 2. I am subject to backup withholding because I have been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, 3. I am a U.S. person or U.S. resident alien, and 4. I am exempt from FATCA reporting.

What is this?

If you have any questions about how to complete this section please download instructions.

Co-Applicant Additional Information

• OK Are you a US Citizen? is required

  Are you a US Citizen?

  • Yes
  • No
• How long have you lived in the US?
  OK How long have you lived in the US? is required
• OK Do you have permission to work in the US? is required

  Do you have permission to work in the US?

  • Yes
  • No
• OK Are you, or any of your relatives, connected to the government of a country other than the US? is required

  Are you, or any of your relatives, connected to the government of a country other than the US?

  • Yes
  • No
• Please explain
  OK Please explain is required
• Place of employment
  OK Place of employment is required
• Occupation
  OK Occupation is required
• OK Do you have any accounts at other financial institutions? is required

  Do you have any accounts at other financial institutions?

  • Yes
  • No
• Where?
  OK Where? is required
• What is the purpose of this account?
  OK What is the purpose of this account? is required
• What is the anticipated average balanc of the account?
  OK What is the anticipated average balanc of the account? is required
• OK Will any proceeds from business activities be deposited ino this account? is required

  Will any proceeds from business activities be deposited ino this account?

  • Yes
  • No
• Type of business
  OK Type of business is required
• Percentage of total deposits
  OK Percentage of total deposits is required
• OK What type of items do you expect to be deposited into the account? Check all that apply. is required

  What type of items do you expect to be deposited into the account? Check all that apply.

  • Cash
  • Direct Deposit
  • Checks
  • Wires
• Frequency of Cash Deposit
  OK Frequency of Cash Deposit is required
• Average Cash Deposit
  OK Average Cash Deposit is required
• Frequency of Direct Deposit
  OK Frequency of Direct Deposit is required
• Average Direct Deposit
  OK Average Direct Deposit is required
• Frequency of Checks Deposit
  OK Frequency of Checks Deposit is required
• Average Checks Deposit
  OK Average Checks Deposit is required
• Frequency of Wire Deposit
  OK Frequency of Wire Deposit is required
• Average Wire Deposit
  OK Average Wire Deposit is required
• OK What method will be used to remove funds from the account? Check all the apply. is required

  What method will be used to remove funds from the account? Check all the apply.

  • Checks
  • ATM/Debit Cards
  • Automated Payments
  • Wires
• Frequency of Wires
  OK Frequency of Wires is required
• Average amount of Wires
  OK Average amount of Wires is required
• OK Will any financial transaction affecting the account originate from or have a destination outside of the US? is required

  Will any financial transaction affecting the account originate from or have a destination outside of the US?

  • Yes
  • No
• Please explain
  OK Please explain is required
• OK Will any of your income come from the sell or distribution of marijuana? is required

  Will any of your income come from the sell or distribution of marijuana?

  • Yes
  • No

Important Information About Procedures for Opening a New Account:

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.

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