FSB-Lake Benton
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*Indicates a Required Field

Online Banking Application

You must be 18 years of age to inquire about an account over the Internet. If you are under 18 years of age, please visit our branch office.

Customer General Information

Date:

First Name: *

Middle Initial:

Last Name: *

Address: *

 

City: *

State & ZIP: *

,

Home Phone: *
(000-000-0000)

Daytime Phone: *
(000-000-0000)

Date of Birth: *
(mm/dd/yyyy)

Email Address: *
(youraddress@yourhost.com)

Please Note: If you are applying for Online Banking, you will not be required to visit a branch to complete the process. You will receive your Online Banking ID and Password in the next 5 business days.

*Indicates a Required Field

Online Banking

Please give me access to and the ability to transfer funds between the following listed accounts on which I am an owner.

Account Number

Descriptive Name

 

Additional Information

Social Security Number: *
(000-00-0000)

Driver's License or State ID Number: *

State of Driver's License or State ID: *


Contact Information

How would you prefer to be contacted? *

Phone

E-Mail

Mail

   
 
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