Franklin Savings Bank

603.934.4445, 1.800.372.4445

Smarter Banking. Easier Living.

New Deposit Account Application

Thank you for your interest in a Franklin Savings Bank account!

We look forward to processing this application request for you.

Please note that this is an online application to apply for the following Franklin Savings Bank accounts: Health Savings Accounts (HSAs), Individual Retirement Accounts (IRAs), Kids' Accounts, and all Business Accounts. Due to the personal contact we would like to have with you for these account openings, these accounts cannot be fully opened online. All other deposit accounts may be opened online.

Please keep in mind that Franklin Savings Bank is a community bank serving the Central New Hampshire area. Our website is provided as a convenience to our customers and local communities and those individuals or businesses planning to relocate to Central New Hampshire. Franklin Savings Bank normally does not provide banking services and products outside the Central New Hampshire area, but we do appreciate your interest.

It is our policy to supplement the disclosures available on the www.fsbnh.bank web site with paper copies once the account application is processed. Upon receipt of this application, we will mail you the proper disclosures.

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.

E-Mail Address:
Type of Account:

Please check if you wish to apply for a debit card (checking and statement savings only)

Term: (Certificates of Deposit or IRAs Only)

Initial Deposit:
Form of Deposit:

From FSB Account #
Ownership of Account:


Applicant Information
First Name:
Middle Initial:
Last Name:
Date Of Birth:
SSN:
Mailing Address:
	City:
	State:
	Zip:
Residence Address:
	City:
	State:
	Zip:
Home Phone #:
Cell Phone #:
Business Phone #:
Drivers License #: (Please forward copy of Driver's License for our records)
Employer:
Mother's Maiden Name:
City Born In:
Favorite Color:

Joint Applicant Information (If Applicable):

First Name:
Middle Initial:
Last Name:
Date Of Birth:
SSN:
Mailing Address: (If different)
	City:
	State:
	Zip:
Residence Address:
	City:
	State:
	Zip:
E-Mail Address:
Home Phone #:
Cell Phone #:
Business Phone #:
Drivers License #:
Employer:
Mother's Maiden Name:
City Born In:
Favorite Color:

Signature(s) -- The undersigned agree(s) to the terms stated in this form and acknowledge(s) receipt of a completed copy on today's date. I also agree that the bank may mail all account disclosures to the address listed above prior to opening the new account.

Signature(s):

	1.
	2.
	3.
	4.


Applicant Backup Witholding Certification
Taxpayer ID Number:	If Taxpayer ID is same as your SSN, leave blank
Certification under penalties of perjury, I certify that the following information is correct.


		TAXPAYER ID NUMBER: My correct Taxpayer Identification Number (TIN) is shown above.
		BACKUP WITHHOLDING: I am not subject to backup withholding because either I have not been notified of being subject to backup withholding as a result of failure to report all interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding.
		EXEMPT RECIPIENTS: I am an exempt recipient under the Internal Revenue Service (IRS) Regulations.


PLEASE NOTE: Due to security regulations, your signature must be on file and your initial deposit received and cleared before your account will be opened.

I will print this application, sign it, and mail it to:
Attn: Customer Service Team Franklin Savings Bank 387 Central Street Franklin, NH 03235

Primary Applicant Signature:		Date:

Joint Applicant Signature:		Date:


I will submit this form electronically and an application will be mailed to me for my signature.

Please ensure that all of the information is correct before submitting your application.