I’m interested in opening an account: * - Select an option - Personal Checking Personal Savings Teen Checking Kids First Savings Certificate of Deposit Health Savings Account
Personal Information
First Name & Middle Initial: *
Last Name: *
Citizenship Status: * - Select an option - U.S. Citizen Resident Alien Non-Resident Alien Other
Home Street Address: *
City: *
State: * Alabama Alaska American Samoa Arizona Arkansas Armed Forces - Americas Armed Forces - Europe/Africa/Canada Armed Forces - Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code: *
Mobile Phone Number: *
Home Phone Number (Optional):
Email Address: *
Will there be a Joint Owner on the account?: - Select an option - Yes No
What checking account type would you like?: * - Select an option - Simple Cash Back Interest Rewards Premier
Would you like a debit card with this account?: - Select an option - Yes No
Would you like to sign up for direct deposit?: - Select an option - Yes No
How would you like to fund your new checking account?
Deposit Amount: *
Transfer from an existing account?: - Select an option - Yes No
Personal Information
First Name & Middle Initial: *
Last Name: *
Citizenship Status: * - Select an option - U.S. Citizen Resident Alien Non-Resident Alien Other
Home Street Address: *
City: *
State: * Alabama Alaska American Samoa Arizona Arkansas Armed Forces - Americas Armed Forces - Europe/Africa/Canada Armed Forces - Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code: *
Mobile Phone Number: *
Home Phone Number (Optional):
Email Address: *
Will there be a Joint Owner on the account?: - Select an option - Yes No
What savings account type would you like?: * - Select an option - Standard Savings Money Market Celebration Savings
Would you like to sign up for direct deposit?: - Select an option - Yes No
How would you like to fund your new savings account?
Deposit Amount: *
Transfer from an existing account?: - Select an option - Yes No
Personal Information
First Name & Middle Initial of Minor Applicant: *
Last Name of Minor Applicant: *
Citizenship Status: * - Select an option - U.S. Citizen Resident Alien Non-Resident Alien Other
Home Street Address: *
City: *
State: * Alabama Alaska American Samoa Arizona Arkansas Armed Forces - Americas Armed Forces - Europe/Africa/Canada Armed Forces - Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code: *
Phone Number:
Email Address:
Promotional Code:
Name(s) of Parent(s) or Legal Guardian Serving as Joint Owner of the Minor Account: *
Parent/Guardian Email Address: *
Parent/Guardian Phone Number: *
Questions? Comments?
Enter any questions or comments here.:
Make Your Selections
Which checking account type would you like?: * - Select an option - Simple Cash Back Interest Rewards Premier
Would you like a debit card with this account?: - Select an option - Yes No
Would you like to sign up for direct deposit?: - Select an option - Yes No
How would you like to fund your new checking account?
Deposit Amount? (Minimum $10): *
Transfer from an existing account?: * - Select an option - Yes No
Personal Information
First Name & Middle Initial of Minor Applicant: *
Last Name of Applicant: *
Citizenship Status: * U.S. Citizen Resident Alien Non-Resident Alien Other
Home Street Address: *
City: *
State: * Alabama Alaska American Samoa Arizona Arkansas Armed Forces - Americas Armed Forces - Europe/Africa/Canada Armed Forces - Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code: *
Phone Number:
Email Address:
Names(s) of Parent(s) or Legal Guardian Serving as Joint Owner of the Minor Account: *
Parent/Guardian Email Address: *
Parent/Guardian Phone Number: *
Questions? Comments?
Enter any questions or comments here:
How would you like to fund your new KidsFirst Savings account?
Deposit Amount (Minimum $10): *
Transfer from an existing account?: * Yes No
Personal Information
First Name & Middle Initial: *
Last Name: *
Citizenship Status: * - Select an option - U.S. Citizen Resident Alien Non-Resident Alien Other
Home Street Address: *
City: *
State: * Alabama Alaska American Samoa Arizona Arkansas Armed Forces - Americas Armed Forces - Europe/Africa/Canada Armed Forces - Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code: *
Mobile Phone Number: *
Home Phone Number (Optional):
Email (valid email address required): *
Will there be a Joint Owner on the account?: - Select an option - Yes No
Joint Owner First Name & Middle Initial:
Joint Owner Last Name:
Joint Owner Mobile Phone Number:
Joint Owner Email:
Desired Number of Months/Years (Term):
Amount of Funds Available for Deposit:
Comments:
Contact Information
Applicant Name: *
Street Address: *
City: *
State: * Alabama Alaska American Samoa Arizona Arkansas Armed Forces - Americas Armed Forces - Europe/Africa/Canada Armed Forces - Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code: *
Phone Number: *
Email Address: *
Name of Employer: *
Employer Address: *
Verification of Eligibility
According to the IRS rules, only qualified individuals are eligible to open a Health Savings Account. Please read the following information and then check the box to confirm your eligibility.
Are covered under a qualifying high-deductible health plan which meets the minimum deductible and the maximum out-of-pocket threshold for the year.
Are not covered by any other medical plan, such as a spouse’s plan.
Are not enrolled in Medicare.
Are not claimed as a dependent on someone else’s tax return.
Have not used Veterans Administration medical benefits in the past three months (exceptions apply to veterans enrolled in a high-deductible health plan who either have a service-connected disability or have only accessed disregarded coverage and preventive services in the past three months.
Do not have any disqualifying alternative medical savings accounts, like a Flexible Spending Account or Health Reimbursement Account.
Eligibility Confirmation: * - Select an option - Eligible Not Eligible Unsure
Insurance Coverage
To be eligible for an HSA, you must be enrolled in a High-Deductible Health care Insurance Plan. Please respond to the questions below about your insurance coverage.
Name of Insurance Provider: *
Coverage Effective Date: *
Coverage Type:
Final Steps
You are making excellent progress toward the opening of your HSA and are on your way to benefitting from its triple-tax advantages. A Relationship Banker will be contacting you to finalize any details about your HSA, including:
Beneficiary Designation. Another benefit of having an HSA is that if you accumulate more money than you need in your account, the unused funds will go to your beneficiary when you die. The named beneficiary(ies) determines how your HSA money is handled after you die.
Identity Verification. Examples of acceptable identity verification documents include:
For address verification: A driver's license, state identification, bank statement, or a current phone or utility bill displaying the input address. Note: You must use your residential address, not a P.O. Box. For a Social Security number: A social security card.For date of birth: A driver's license, U.S. passport, birth certificate, or state identification.For name validation: A social security card, passport, birth certificate, divorce decree, legal name change certificate, or state identification.
Once details are finalized, you can sign documents electronically through DocuSign or in-person at a First National Bank location.
Thanks for selecting First National Bank as place to service your financial needs. You will hear from us soon!
Consent Confirmation:
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Preferred Dog Color: *
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