Product

What you’ll need to apply

Checking Account
Performance Checking Account	Minimum Initial Deposit $100	View Product Rates

Money Market Accounts
Performance Money Market Account	Minimum Initial Deposit $100	View Product Rates
Plus Money Market Account	Minimum Initial Deposit $25,000	View Product Rates

Health Savings Accounts
HSA Checking Account	Minimum Initial Deposit $100	View Product Rates
HSA Money Market Account	Minimum Initial Deposit $100	View Product Rates

Certificate of Deposit Accounts
Certificate of Deposit Account	Minimum Initial Deposit $1,000	View Product Rates
Select Term

Individual Retirement Accounts
Traditional IRA	Minimum Initial Deposit - CDs $1,000, MMA varies	View Product Rates
Roth IRA	Minimum Initial Deposit - CDs $1,000, MMA varies	View Product Rates
Coverdell Education Savings Account	Minimum Initial Deposit - CDs $1,000, MMA varies	View Product Rates

Account Options

Membership


* Do you already have a Farm Bureau Bank account?		Yes No
	*Account Number	*Last 4 Social Security #

A previous account has been found, would you like to prefill your application? Yes No Note: If you change any existing information, we will not provide access to your new account until the updated information can be verified.

* Are you a Farm Bureau Member?		Yes No
	Membership Number	State of Membership	County of Membership

Farm Bureau membership is not required. However, Farm Bureau members may be eligible for special offers and promotions from Farm Bureau Bank.

Were you referred by a Farm Bureau Bank Agent?		Yes No
	Agent RSC	*Agent Name	Agent State

By entering this information, you understand that this Farm Bureau Agent has requested that Farm Bureau Bank, P.O. Box 33427, San Antonio, Texas 78265-9865, open a deposit account for you. Limited information pertaining to your application may be shared with this agent in order to assist in the application process. To inquire about the status of your application, please contact Farm Bureau Bank at 1-800-492-3276.

How did you hear about us?

Personal Information

Beneficiary

The percentage will be divided equally among beneficiaries. If you would like an unequal percentage or would like to add more than two beneficiaries, please contact 1-800-492-3276.
Number of beneficiaries:

BENEFICIARY 1 INFORMATION
	First Name	MI Last Name
*Name:
*Relationship:		Date of Birth: mm/dd/yyyy

BENEFICIARY 2 INFORMATION
	First Name	MI Last Name
*Name:
*Relationship:		Date of Birth: mm/dd/yyyy

Summary

APPLICANT

Personal Information
Applicant Name:
Physical Address:
Mailing Address:
Home Phone:
Mobile Phone:
Email Address:
Employer:
Employer Phone:

Security Information
Social Security Number:
Date of Birth:
Mother's Maiden Name:
Driver's License Number:
Driver's License State:
Backup Withholding:

JOINT APPLICANT

Personal Information
Joint Applicant Name:
Physical Address:
Mailing Address:
Home Phone:
Mobile Phone:
Employer:
Employer Phone:

Security Information
Relationship to Applicant:
Social Security Number:
Date of Birth:
Driver's License Number:
Driver's License State:

BENEFICIARY

Beneficiary 1
Full Name:
Relationship:
Date of Birth:

Beneficiary 2
Full Name:
Relationship:
Date of Birth:

APPLYING PRODUCT

Applying Product:

ACCOUNT OPTIONS

Account Options:
Free Checks:

Debit Card:

E-Option:

Overdraft Protection:

Tie to Farm Bureau Bank account:

Tie to Farm Bureau Bank Credit Card:

Account Options:
Step-Up Option:

Interest Transfer:

To Farm Bureau Bank account:

To other bank account:

Account Options:
E-Option: YES

MEMBERSHIP & AGENT REFERRAL

Farm Bureau Membership
Member Number:
Membership State:
Membership County:

Farm Bureau Bank Agent Referral
Agent RSC:
Agent Name:
Agent State:

Disclosures

How would you prefer your documents?
Electronic	You will be able to access all disclosures, agreements, and instructions electronically. Our Deposit Terms, including our Fee Schedule, is available any time at www.farmbureau.bank.
By Mail	All disclosures, agreements, and instructions will be mailed to your address seven to ten business days after the account has been opened and funded. Our Deposit Terms, including our Fee Schedule, is available any time at www.farmbureau.bank.

ELECTRONIC SIGNATURE AGREEMENT

By choosing Electronic, you allow Farm Bureau Bank to shorten the time it takes to open a deposit account by authorizing us to provide the following items electronically, rather than by mail:

An application and all related account disclosures.
Special instructions for any additional options elected during the application process.

CONSENT

By selecting 'Yes' for "Do you agree to the Electronic Signature Agreement", you CONSENT to all disclosures, agreements, and instructions and receiving them electronically for this specific account. By consenting, the electronic documents may be printed or saved on your personal computer.

If you do not agree with the disclosures, agreements, and instructions or do not wish to receive them electronically, you can select 'No' and Farm Bureau Bank will mail all of the documentation to your address listed on the application.

* DISCLOSURES
Documents are in PDF format and require free Adobe Reader^® software to view them.

These documents and disclosures will apply to your account. Please review each one below by clicking on each document link. By selecting 'Yes' for "Do you agree to the Electronic Signature Agreement", you CONSENT to all disclosures. If you do not agree to any/all of the disclosures, select 'No' and you will continue through the account opening process, but will receive all documentation by regular mail and you will have the opportunity to record your concerns in Additional Comments/Questions at the end of the application.

I have read and agree to all the disclosures above and have the software that enables me to access and retain them. for a test PDF to check if your system can open our electronic documents.

Free copies of the disclosures and agreements are available via our Disclosures page on our website at .

SYSTEM REQUIREMENTS

To utilize the electronic option, the following requirements must be met:

Need a valid e-mail address.
Must have a personal computer or other device and have access to the Internet
Must have an Internet browser which supports 128-bit encrypted communications.
Must have software to receive and access Farm Bureau Bank Documents, which are in Portable Document Format (PDFs).
Must have the ability to retain electronic documents by downloading them to your system or onto a disk, or have the ability to print these documents for your records.

If you do not have the minimum requirements above, click 'No' to "Do you agree to the Electronic Signature Agreement?" and Farm Bureau Bank will mail all the required documentation to the address on the application.

* Do you agree to the Electronic Signature Agreement?

Funding Options

Please provide your Internal Tracking Code.
ITC

To help you get the most out of your new account, here are a few more valuable services for you. If the option is automatic, then the select box is permanently checked.
Free Checks	Free checks upon request. Check writing privileges may be limited depending on the type of account. Please refer to the Terms and Conditions.
Visa^® Debit Card	Your account comes equipped with a FREE Visa Debit Card to have universal access to your funds. Purchases can be made anywhere Visa is accepted. It works like a credit card except that funds are automatically removed from your account when the card is used. It can also be used to withdraw funds from more than 300,000 ATM machines worldwide. Usage may be limited depending on the type of account. Please refer to the Terms and Conditions.
E-Option	E-Option is a paperless statement option. It may earn a higher rate than a non E-Option account. If you select E-Option, you will not receive a paper statement. You will view your monthly statements electronically by logging into Online Banking.
Overdraft Protection	Linking your Farm Bureau Bank checking, money market or credit card account will protect you from returned checks and overdraft charges.
	Link to my Farm Bureau Bank checking or Money Market account
	*Account Number:
	Link to my Farm Bureau Bank Visa or MasterCard
	*Visa or MasterCard Number:

To help you get the most out of your new account, here are a few more valuable services for you.
Step-Up Option	For 1-5 year CD only. Step-Up Option allows a one time rate increase during your CD term. You choose when to use this option.
Interest Transfer Option	Earned interest is automatically applied to your Certificate of Deposit Account on a monthly basis. Select Interest Transfer Option if you would like the interest transferred to a different account.
	Transfer interest to my Farm Bureau Bank Deposit account
	*Account Number:
	Transfer interest to another bank account
	*Routing Number:
	*Account Number:
	*Account Type:Checking Savings

YOUR INFORMATION
	First Name	MI Last Name
*Your Name:
*Physical Address:		(No Post Office Boxes)
*Physical City:		* *Zip:
Mailing Address:	Different from physical address? Yes No
*Address:
*City:		* *Zip:
Home Phone:	()-	Mobile Phone:	()-
*At least one phone number is required
* E-mail Address:		* Confirm E-mail:
Employer:		Employer Phone:	()-

YOUR SECURITY INFORMATION
*Social Security Number:	--
*Date of Birth:		mm/dd/yyyy
Mother's Maiden Name:
Driver's License Number:		State of Issue:

BACKUP WITHHOLDING CERTIFICATION
Under penalties of perjury, you certify that: (1) the Social Security Number/Taxpayer Identification Number provided on this application is your correct number and; (2) unless you have indicated "Yes" following this statement, you are not subject to backup withholding because (a) you are exempt from backup withholding, or (b) you have not been notified by the Internal Revenue Service (IRS) that you are subject to backup withholding as a result of your failure to report all interest or dividends, or (c) the IRS has notified you that you are no longer subject to backup withholding; and (3) you are a U.S. person (including U.S. resident alien).
* Have you been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return? Yes No

Primary applicant must be 18 years of age; if not, a joint applicant 18 years of age or older is required.
* Are you applying for a JOINT account? Yes No

JOINT APPLICANT INFORMATION
A Joint Applicant has full access, liability, rights and responsibilities to a Farm Bureau Bank Deposit Account.
For Health Saving Accounts, a joint applicant will be treated as an authorized signer.
	First Name	MI Last Name
*Joint Applicant Name:
*Relationship to Applicant:
*Physical Address:	Same as primary applicant's address? Yes No
*Address:		(No Post Office Boxes)
*City:		* *Zip:
*Mailing Address:	Same as primary applicant's mailing address? Yes No
*Address:
*City:		* *Zip:
Home Phone:	()-	Mobile Phone:	()-
*At least one phone number is required
Employer:		Employer Phone:	()-

JOINT APPLICANT SECURITY INFORMATION
*Social Security Number:	- -
*Date of Birth:		mm/dd/yyyy
Driver's License Number:		State of Issue:
To add additional Joint Applicant(s) please call 1-800-492-3276

USA PATRIOT ACT (Section 326) 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 the 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. Please note that Farm Bureau Bank may monitor and/or record phone conversations made or received by our employees or our agents.

*How would you like to make your deposit to your account?
Transfer from FARM BUREAU BANK checking or savings account
*Account Number:
*Confirm Account Number:

Electronic Funds Transfer from external checking or savings account
*Financial Institution Name:
*Routing Number:
*Account Number:
*Confirm Account Number:
*Account Type:	Checking Savings

Please verify that the information above is correct for processing. Electronic Funds Transfers (EFT) are subject to verification procedures. I hereby authorize Farm Bureau Bank to initiate an EFT debit to my account at the financial institution indicated above for the initial deposit amount.

Wire Transfers (I'll initiate a wire transfer request from my bank and wire the funds to Farm Bureau Bank)
Wire Transfers instructions:	Farm Bureau Bank Routing Number: 121281892 Your Social Security number 17300 Henderson Pass San Antonio, Texas 78232 Phone: 1-800-492-3276 Comments: Farm Bureau Bank new account

I will send a CHECK by MAIL (Please do so within 5 business days after opening your account)
Mail your check to:	Farm Bureau Bank ATTN: Deposit Services 17300 Henderson Pass San Antonio, Texas 78232-1663

Other (This is an Employer Funded Account for a HSA)
*Name of Employer:
Health Plan Coverage Type:	Single Family

*Is this a HSA Rollover?	Yes No
*HSA Rollover Amount:	$ Do not enter $ or comma

*Initial Opening Deposit Amount:	$ Do not enter $ or comma
The account you are making your initial deposit from must have the requested funds available. Interest will start accruing from the day your account is funded. You will not have access to your account until the bank has received the required minimum deposit.

A copy of the applicant(s) identification is required to process this application. Please email a copy (or photo) of each applicant's driver's license (or state ID) to services@farmbureaubank.com. For UTMA (minor) applications, please email a copy (or photo) of the minor's birth certificate AND social security card to services@farmbureaubank.com.
*I have read and agree to the above identification requirements.

Additional Comments/Questions: