To sign up for Internet Banking, please complete, print, sign and mail this application to First State Bank, P.O. Box 160, Shallowater, TX 79363. In a few days, you will receive an e-mail containing a temporary password along with user instructions.
This is the only application that you will be required to complete for all of your accounts. Once your primary account (your main checking account) is setup then all other accounts that you have with us will be included. We require only one application for joint accounts or per household. If you have a special need to keep certain accounts that you have private from other individuals in your business or household please contact us.
First Name: _________________________ Last Name: ____________________________________
Address: _________________ City: ________________ State: _____________ Zip: _____________
Cell Phone #: ___________________ Email Address: _________________________
Home Phone #: _________________________
Social Security #: _____________________ Primary Checking Account #: ______________________
Please list both the type of account(s) and the account number for each one that you would like to be included on your Internet banking account.
Account Type (Example: Checking, loans, IRA) Account Number
We collect nonpublic personal information about you
from the following sources:
« Information we receive from you on applications or other forms;
« Information about your transactions with us, our affiliates, or others; and
« Information we receive from a consumer reporting agency.
We restrict access to nonpublic information about you to those employees who need to know that information to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with Federal standards to guard your nonpublic personal information.
We do not disclose any nonpublic information about our customers or former customers or anyone, except as permitted by law. First State Bank, Shallowater is chartered under the laws of the State of Texas and by state law is subject to regulatory oversight by the Texas Department of Banking. First State Bank also engages in business of selling money orders and traveler’s checks as an agent for American Express, which is licensed under the laws of the State of Texas and is subject to regulatory oversight by the Texas Department of Banking. Any consumer wishing to file a complaint against The First State Bank, Shallowater should first contact First State Bank, Shallowater, if you still have unresolved complaints regarding the company’s money transmission or currency exchange activity, consumers may file complaints with the Texas Department of Banking through one of the means indicated below:
In Person or U. S. Mail: 2601 North Lamar Boulevard, Suite 300, Austin, Texas 78705-4294
Telephone Number: 877-276-5554
Fax Number: 512-475-1313
I certify by my signature that I have read every aspect of this application and understand fully all of the material contained within.
Applicants signature Date