Secure Overdraft Privilege Opt-In/Opt-Out Form

If you want First State Bank to authorize and pay overdrafts on your ATM and everyday debit card transactions select the Opt-In option when completing the form. If you do not want First State Bank to authorize and pay overdrafts on your ATM and everyday debit card transactions select the Opt-Out option when completing the form.

To fill out this information, list your checking accounts, and select "Opt In" for this service on that account. Please refer to your account opening disclosures or you may contact First State Bank at 979-265-2511 for a full description of our Overdraft Privilege service or if you have any further questions.

Account Number - Enter the last 4 digits of your checking account number(s) exactly as they appear on your First State Bank statement.
If you have more than 5 checking accounts please send an additional form for your remaining accounts.

Required Field

Personal Information

First Name Last Name Daytime Phone Number E-mail Address Account Number Optin or Optout Account Number Optin or Optout Account Number Optin or Optout Account Number Optin or Optout Account Number Optin or Optout