Applicant Information

Eligibility

In order to open an account with Fayetteville Bank you must be an existing customer or live in the State of Texas.

• Please confirm your eligibility:

  • I certify that I live in the state of Texas.
  • I am an existing customer of Fayetteville Bank.
  OK Please confirm your eligibility: is required

In order to open a Health Savings Account you must meet certain criteria.

HSA eligibility requirements

• Please confirm your eligibility to open an HSA account

  • I certify that I have read the eligibility requirements and qualify to open an HSA.
  • I am not applying for an HSA account.
  OK Please confirm your eligibility to open an HSA account is required

• Please enter the code to confirm your ability to view the required Portable Document Format (PDF) files. If the code isn't visible, click here to see code in new window or visit your nearest branch to apply for an account.

  We ask that you confirm your ability to download, open, and view the required Portable Document Format (PDF) files. Once you have entered the confirmation code, you may close the PDF document and continue the application process.

  
  

  Click here for your confirmation code.

• Enter code
  OK Error - Please enter the code to verify that you can view the required Portable Document Format (PDF) files. If the code isn't visible you will need to visit your nearest branch to apply for an account.

Basic Info

• First Name
  OK First Name is required
• Last Name
  OK Last Name is required
• Email Address
  OK Email Address is required
• Phone
  OK Phone is required
• Date of Birth
  OK Date of Birth is required
• Social Security Number
  OK Social Security Number is required

Address

• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip Code
  OK Zip Code is required
• • Mailing address is different (Optional)
  OK Mailing address is different (Optional) is required

Mailing Address

• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip Code
  OK Zip Code is required

Previous Address

• Have you lived at this address for less than 2 years?

  • No
  • Yes
  OK You must select one of the following.
• Previous Address
  OK Previous Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip Code
  OK Zip Code is required

Identification

• What form of ID would you prefer to use?

  • Drivers license or state-issued ID
  • US Passport
  OK What form of ID would you prefer to use? is required
• License Number
  OK License Number is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Expiration Date
  OK Expiration Date is required
• Passport Number
  OK Passport Number is required
• Expiration Date
  OK Expiration Date is required

Tax Status

• • I am not subject to backup withholding. This is most common. Under penalties of perjury, I certify that 1. My Social Security number is correct, 2. I am not subject to backup withholding because (a) I am exempt from backup withholding, (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, 3. I am a U.S. citizen or U.S. resident alien, and 4. I am exempt from FATCA reporting.
  • I am subject to backup withholding. You will know if this applies to you. Under penalties of perjury, I certify that 1. My Social Security number is correct, 2. I am subject to backup withholding because I have been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, 3. I am a U.S. person or U.S. resident alien, and 4. I am exempt from FATCA reporting.
  OK Please select one of the following.

What is this?

If you have any questions about how to complete this section please download instructions.

Beneficiary

• Would you like to add a beneficiary to this account?

  • Yes
  • No
  OK Would you like to add a beneficiary to this account? is required
• • Beneficiary 1
  Optional OK Beneficiary 1 is required
• Name
  OK Name is required
• Date of Birth
  (optional) OK Date of Birth is required
• Social Security Number
  (optional) OK Social Security Number is required
• • Beneficiary 2
  Optional OK Beneficiary 2 is required
• Name
  OK Name is required
• Date of Birth
  (optional) OK Date of Birth is required
• Social Security Number
  (optional) OK Social Security Number is required
• • Beneficiary 3
  Optional OK Beneficiary 3 is required
• Name
  OK Name is required
• Date of Birth
  (optional) OK Date of Birth is required
• Social Security Number
  (optional) OK Social Security Number is required

Regulatory Regulations

• What is your Employment Status? EmployedSelf-EmployedUnemployedStudentForeign StudentRetiredHomemakerMinorDisabled
  OK What is your Employment Status? is required
• If you selected Employed, Self-Employed, Unemployed, Retired, or Disabled above, complete the following: What was/is your occupation- answer No Former Occupation, if applicable.
  Optional OK If you selected Employed, Self-Employed, Unemployed, Retired, or Disabled above, complete the following: What was/is your occupation- answer No Former Occupation, if applicable. is required

• Are you a frequent traveler (International travel, more than 5 times per year)

  • Yes
  • No
  OK Are you a frequent traveler (International travel, more than 5 times per year) is required
• If answered yes, what countries do you travel?
  Optional OK If answered yes, what countries do you travel? is required

• Do you act as an intermediary between your clients and the bank, performing services or arranging for services to be performed on your client's behalf? (Professional Service Provider)

  • Yes
  • No
  OK Do you act as an intermediary between your clients and the bank, performing services or arranging for services to be performed on your client's behalf? (Professional Service Provider) is required

• What is the source of the deposits into your account?

  • Bank Draft
  • Employment Income
  • Gift
  • Grants/Scholarships
  • Internal Transfer
  • Investment Income Savings
  • Loan(s)
  • Retirement/Pension Income
  • Trust
  • Other
  OK What is the source of the deposits into your account? is required

• Will you deposit or write checks?

  • Yes
  • No
  OK Will you deposit or write checks? is required

• Will you deposit or withdrawal cash?

  • Yes
  • No
  OK Will you deposit or withdrawal cash? is required

• Will you send or receive wire transactions?

  • Yes
  • No
  OK Will you send or receive wire transactions? is required

• If you answered Yes above (wires); will these be sent to or received from non-US locations?

  • Yes
  • No
  Optional OK If you answered Yes above (wires); will these be sent to or received from non-US locations? is required
• If you answered Yes above (international wires; which countries do you expect to send/receive wires?
  Optional OK If you answered Yes above (international wires; which countries do you expect to send/receive wires? is required

• Will you send or receive electronic (non-wire) transactions? (ACH, Debit Card, P2P, Online Bill Payments)

  • Yes
  • No
  OK Will you send or receive electronic (non-wire) transactions? (ACH, Debit Card, P2P, Online Bill Payments) is required

• If you answered Yes above (electronic transactions), will these be sent or received from non-US locations?

  • Yes
  • No
  Optional OK If you answered Yes above (electronic transactions), will these be sent or received from non-US locations? is required
• If you answered Yes above (international electronic transfers); which countries do you expect to send/receive wires?
  Optional OK If you answered Yes above (international electronic transfers); which countries do you expect to send/receive wires? is required

• Are you a US Citizen?

  • Yes
  • No
  OK Are you a US Citizen? is required

If you answered No above, provide proper documentation when requested (Green Card, ITIN, etc).

• Do you have citizenship with any other country?

  • Yes
  • No
  OK Do you have citizenship with any other country? is required
• If you answered Yes above, to which other countries do you have citizenship?
  Optional OK If you answered Yes above, to which other countries do you have citizenship? is required

• Are you a Politically Exposed Person? In financial regulation, a politically exposed person is one who has been entrusted with a prominent public function.

  • Yes
  • No
  OK Are you a Politically Exposed Person? In financial regulation, a politically exposed person is one who has been entrusted with a prominent public function. is required

Additional Information

• Enter Security Code to be used for eSignature Authentication
  
  

  Please provide a 4 digit numeric value code. This code will be used to authenticate yourself when your eSignature documents are delivered.

  OK

  Please Enter Security Code - 4 Digit Code - Numeric Value only.

  To be used for eSignature authentication

• Name of Employer
  OK Name of Employer is required
• Occupation
  OK Occupation is required

• Would you like a debit card for this account? If applying for a savings account it will be an ATM card only, not a debit card.

  • Yes
  • No
  OK Would you like a debit card for this account? If applying for a savings account it will be an ATM card only, not a debit card. is required

• Do you sell, process or grow HEMP, CBD or Marijuana products?

  • Yes
  • No
  OK Do you sell, process or grow HEMP, CBD or Marijuana products? is required

Please click here for more information about overdraft and overdraft fees.

Overdraft protection is only available for checking accounts.

• Please make a selection

  • I am applying for an HSA or savings account and understand overdraft protection is not available for this account.
  • I do not want Fayetteville Bank to authorize and pay overdrafts on my ATM and everyday debit card transactions.
  • I want Fayetteville Bank to authorize and pay overdrafts on my ATM and everyday debit card transactions.
  OK Please make a selection is required

Joint Applicant

Joint applicants are not available for HSA accounts.

• Will this be a joint account?

  • No, I am the only applicant
  • Yes, I have a co-applicant
  OK Will this be a joint account? is required

Co-Applicant Basic Info

• First Name
  OK First Name is required
• Last Name
  OK Last Name is required
• Email
  OK Email is required
• Phone
  OK Phone is required
• Date of Birth
  OK Date of Birth is required
• Social Security Number
  OK Social Security Number is required

Co-Applicant Address

• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip Code
  OK Zip Code is required
• • Mailing address is different
  Optional OK Mailing address is different is required

Co-Applicant Mailing Address

• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip Code
  OK Zip Code is required

Co-Applicant Previous Address

• Have you lived at this address for less than 2 years?

  • No
  • Yes
  OK You must select one of the following.
• Previous Address
  OK Previous Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip Code
  OK Zip Code is required

Co-Applicant Identification

• What form of ID would you prefer to use?

  • Drivers license or state-issued ID
  • US Passport
  OK What form of ID would you prefer to use? is required
• License Number
  OK License Number is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Expiration Date
  OK Expiration Date is required
• Passport Number
  OK Passport Number is required
• Expiration Date
  OK Expiration Date is required

Co-Applicant Tax Status

• • I am not subject to backup withholding. This is most common. Under penalties of perjury, I certify that 1. My Social Security number is correct, 2. I am not subject to backup withholding because (a) I am exempt from backup withholding, (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, 3. I am a U.S. citizen or U.S. resident alien, and 4. I am exempt from FATCA reporting.
  • I am subject to backup withholding. You will know if this applies to you. Under penalties of perjury, I certify that 1. My Social Security number is correct, 2. I am subject to backup withholding because I have been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, 3. I am a U.S. person or U.S. resident alien, and 4. I am exempt from FATCA reporting.
  OK Please select one of the following.

What is this?

If you have any questions about how to complete this section please download instructions.

Co-Applicant Additional Information

• Enter Security Code to be used for eSignature Authentication
  
  

  Please provide a 4 digit numeric value code. This code will be used to authenticate yourself when your eSignature documents are delivered.

  OK

  Please Enter Security Code - 4 Digit Code - Numeric Value only.

  To be used for eSignature authentication

• Name of Employer
  OK Name of Employer is required
• Occupation
  OK Occupation is required

• Please choose one

  • This is a joint account with Rights of Survivorship
  • This is a joint account without Rights of Survivorship
  OK Please choose one is required

• Are you a Politically Exposed Person?

  • Yes
  • No
  OK Are you a Politically Exposed Person? is required

• Would you like a debit card for this account? If applying for a savings account it will be an ATM card only, not a debit card.

  • Yes
  • No
  OK Would you like a debit card for this account? If applying for a savings account it will be an ATM card only, not a debit card. is required

• Do you sell, process or grow HEMP, CBD or Marijuana products?

  • Yes
  • No
  OK Do you sell, process or grow HEMP, CBD or Marijuana products? is required

Please click here for more information about overdraft and overdraft fees.

Overdraft protection is only available for checking accounts.

• Please make a selection

  • I am applying for a savings account and understand overdraft protection is not available for this account.
  • I do not want Fayetteville Bank to authorize and pay overdrafts on my ATM and everyday debit card transactions.
  • I want Fayetteville Bank to authorize and pay overdrafts on my ATM and everyday debit card transactions.
  OK Please make a selection is required

Important Information About Procedures for Opening a New Account:

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

By submitting this application, you agree to the Kasasa Digital Technology Terms of Use Agreement.