CHECK CARD APPLICATION

Please read before filling out application
  • Must be an account holder (cannot be a minor) to apply for the Check card.
  • Power of Attorney's are not honored for the account holder.
  • Application must be mailed in. We cannot accept e-mailed or faxed applications.
Personal Information:
First Name:   Middle Init:   Last Name:
Social Security:      Date of Birth:   Month:  Day:  Year: 
Checking Account #:     Savings Account #: 
Contact Information:
Street: (This card will be mailed to this address) 
City:  State:  Zip: 
Home Telephone Number: Overseas Telephone Number:
Business Telephone Number:         Email Address:
Co-Applicant Information:
Is this a joint account?   Yes           No
First Name:   Middle Init:  Last Name: 
Social Security:      Date of Birth:  Month:  Day:  Year: 
Street: 
City:  State:   Zip: 

Applicant:  X__________________  Date:  _____________

Co-Applicant:  X__________________  Date:  _____________


PLEASE PRINT, SIGN AND RETURN TO:
FSNB, NA
Cards Department
P.O. Box 33009, Fort Sill, OK 73503-3009

  Bank Use Only Date:       Approved By: