Personal New Account Application

You must be 18 years of age or older to complete this form. Please provide all the requested information and you authorize the Bank to verify the information through Chex Systems and OFAC prior to opening the account. When you have completed the form, press SUBMIT button to send your application. You will hear from us within three business days. We will request you to bring two forms of identification and visit one of our branches to open the account. For any assistance in completing this form, kindly call 1-877-256-9809 Monday-Friday.

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Required fields are marked with an asterisk *

Individual Account Joint Account
Other (explain) 

Applicant Information

First Name*
Last Name*
ZIP/Postal Code*
Social Security Number*
- -
Date of Birth*
Home Phone*
Employment Status*
Company Name*
Company Address*
Work Phone*

Drivers License

Best Time to Call*
First Name
Last Name
ZIP/Postal Code
Social Security Number
- -
Date of Birth
Home Phone
Employment Status
Company Name
Company Address
Work Phone

Drivers License

Please open the following accounts:
Regular Checking First Choice Bank Online Banking
Regular Savings ATM Card, Number of Cards
NOW Checking Bill Pay
Certificate of Deposit
Money Market

To indicate a change of address, please use the comments box below.
To reorder checks for your account, please indicate so in the Comments Box, providing your account number, ending check sequence number and the number of boxes requested.


Certification and Agreement

(1) The number(s) shown in this application is/are the correct taxpayer identification number(s) and I/we am/are not subject to backup withholding either because I/we have not been notified that I/we am/are subject to backup withholding as a result of failure to report all interest or dividends, or the IRS has notified me/us that I/we am/are no longer subject to backup withholding.

(2) by the IRS that I/we am/are subject to backup withholding due to notified payee underreporting and I/we have been notified that the backup withholding is terminated.

(3) I/we agree to be bound by the provisions of the applicable disclosure(s) for products I/we have selected. First Choice Bank will furnish such applicable disclosure(s) to me/us within the timeframe(s) prescribed by regulation and I/we will inform First Choice Bank if I/we do not receive full disclosure(s).

Intentionally submitting false information for the purpose of opening an account is considered a criminal activity. Systems have been implemented to identify attempts of fraud.