Prime Benefits Checking

Personal Information

  • Are you a new customer?

    OKAre you a new customer? is required
  • OKName is required
  • Social Security Number

    --
    OKSocial Security Number is required
  • Date of Birth

    OKDate of Birth is required
  • Home Phone

    --
    OKHome Phone is required
  • Daytime Phone

    --
    OptionalOKDaytime Phone is required
  • OKMother's Maiden Name (For Security on Account) is required
  • OKPersonal Email Address is required
  • OKDrivers License Number is required
  • Driver’s License Expiration Date

    OKDate must be in the future

Contact Information

  • OKChoose the location you would like to complete your application is required
  • How would you prefer to be contacted?

    OKHow would you prefer to be contacted? is required
  • When is the best time to arrange an appointment?

    OKWhen is the best time to arrange an appointment? is required

Address Information

  • OKResidential Address (Not a P.O. Box) is required
  • OKCity is required
  • OKState is required
  • OKZip is required
  • Use residential address for mailing address

    OKUse residential address for mailing address is required
  • OKMailing Address (if different than above) is required
  • OKCity is required
  • OKState is required
  • OKZip is required

Joint Account Information

  • Number of Joint Owners on this Account

    OKNumber of Joint Owners on this Account is required

Joint Applicant #1

  • OKRelationship to Primary Applicant is required
  • OKName is required
  • Date of Birth

    OKDate of Birth is required
  • Social Security Number

    --
    OKSocial Security Number is required
  • OKMother’s Maiden Name (For Security on Account) is required
  • OKDrivers License Number is required
  • Driver’s License Expiration Date

    OKDate must be in the future
  • Home Phone

    --
    OKHome Phone is required
  • Work Phone

    --
    OKWork Phone is required
  • OKPhysical Residential Address is required
  • OKCity is required
  • OKState is required
  • OKZip is required
  • Use residential address for mailing address

    OKUse residential address for mailing address is required
  • OKMailing Address (if different from Residential) is required
  • OKCity is required
  • OKState is required
  • OKZip is required

Comments

  • OptionalOK is required

Security Code

  • OK is required

    Fisher National Bank reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, you grant full permission to do so.