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First State Bank

Online Enrollment

Welcome to our Online Enrollment Form.

 Click here to view or download our Online Banking Agreement as a pdf.

* Fields in bold are required

Personal Information:
Full Name:  
Address 1:  
Address 2:
Zip Code:    
Home Phone Number:   ex. xxx-xxx-xxxx
Mobile Phone Number:  
At least one phone number is required.
Work Phone Number:  
Email Address:    
Social Security or Tax ID Number:    
Date of Birth: ex. 03/01/1970    
What is your middle name?  

Account Information:
Account Number
Account Type

Login Information:
Requested User ID:

First State Bank Online Banking Agreement