New Account Application

This is a secure form that will be submitted to First Bank of Owasso.

* indicates a required field

Primary Owner
*Name (First M. Last)
Business Name
*Date of Birth
*Social Security Number
P.O. Box
Street Address
*City, State Zip	,
*Driver's License Number
*Driver's License State
*Employer
*Home Phone
*Work Number

Joint Owner
Name (First M. Last)
Business Name
Date of Birth
Social Security Number
P.O. Box
Street Address
City, State Zip	,
Driver's License Number
Driver's License State
Employer
Home Phone
Work Number

Personal Accounts	Single with POD (Payable on Death) Single without POD Joint with ROS (Right of Survivorship)
List Beneficiaries
Commercial Accounts	Sole Proprietorship Corporation (for profit) Corporation (non-profit) Unincorporated Association Partnership Other

Account Information
Initial Deposit
Previous Bank
Check all services for which you are applying	Check Card ATM Card Merchant Card Processing

If you have any questions, please contact us at (918) 272-5301.
In order for us to process your application correctly, we may need to contact you to verify some of the information or request more necessary documentation. This information will allow us to better satisfy our regulatory requirements to "KNOW YOUR CUSTOMER."

By clicking below, I hereby certify that everything I have stated above is correct. I authorize you to check my credit and employment history and verify other information which I have provided to you.

You may keep this application whether or not it is approved.

Member FDIC

New Account Application

Primary Owner

Joint Owner

Account Information