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Personal Information

Are you a new customer?
- Yes
- No
OK Are you a new customer? is required
Name
OK Name is required
Social Security Number
OK Social Security Number is required
Date of Birth
OK Date of Birth is required
Home Phone
OK Home Phone is required
Daytime Phone
Optional OK Daytime Phone is required
Mother's Maiden Name
OK Mother's Maiden Name is required
Email
OK Email is required

Contact Information

Choose the location you would like to complete your application
OK Choose the location you would like to complete your application is required
How would you prefer to be contacted?
- Phone
- Mail
- Email
OK How would you prefer to be contacted? is required
When is the best time to arrange an appointment?
- Morning
- Lunchtime
- Afternoon
OK When is the best time to arrange an appointment? is required

Address Information

Residential Address (Not a P.O. Box)
OK Residential Address (Not a P.O. Box) is required
City
OK City is required
State
OK State is required
Zip
OK Zip is required
Use residential address for mailing address
- Yes
- No
OK Use residential address for mailing address is required
Mailing Address (if different than above)
OK Mailing Address (if different than above) is required
City
OK City is required
State
OK State is required
Zip
OK Zip is required

Joint Account Information

Number of Joint Owners on this Account
- 0
- 1
- 2
OK Number of Joint Owners on this Account is required

Joint Applicant #1

Relationship to Primary Applicant
OK Relationship to Primary Applicant is required
Name
OK Name is required
Date of Birth
OK Date of Birth is required
Social Security Number
OK Social Security Number is required
Drivers License Number
OK Drivers License Number is required
State Licensed Issued
OK State Licensed Issued is required
Home Phone
OK Home Phone is required
Work Phone
OK Work Phone is required
Residential Address
OK Residential Address is required
City
OK City is required
State
OK State is required
Zip
OK Zip is required

Joint Applicant #2

Relationship to Primary Applicant
OK Relationship to Primary Applicant is required
Name
OK Name is required
Date of Birth
OK Date of Birth is required
Social Security Number
OK Social Security Number is required
Drivers License Number
OK Drivers License Number is required
State License Issued
OK State License Issued is required
Home Phone
OK Home Phone is required
Work Phone
OK Work Phone is required
Residential Address
OK Residential Address is required
City
OK City is required
State
OK State is required
Zip
OK Zip is required

Comments

Optional OK is required

Security Code

OK is required

Farmers & Merchants Bank reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, you grant full permission to do so.