INFIR$T REWARD$ Checking Cash Back Application InFirst Bank

Please note; you may be required to visit one of our offices to finalize the application process.

By clicking the "I Accept" button on the application, you are indicating that you have read and agree to our Terms and Conditions. By clicking "I Accept", you are also agreeing to accept delivery of the Terms and Conditions electronically. You may obtain an additional copy of the Terms and Conditions by visiting any InFirst Bank branch.

Ownership

Primary Account Owner

Maiden Name

Date of Birth(Required)
MM slash DD slash YYYY

SSN(Required)

Home Phone

Work Phone

Driver's License Number

State

Issue Date
MM slash DD slash YYYY

Expiration Date
MM slash DD slash YYYY

Joint Account Owner

(if you selected joint account ownership)

Date of Birth
MM slash DD slash YYYY

SSN

Driver's License Number

State

Issue Date
MM slash DD slash YYYY

Expiration Date
MM slash DD slash YYYY

Payable on Death Beneficiary

(if you selected POD ownership)

SSN

Phone Number

Deposit Information

Initial Deposit

Initial Deposit Type

Taxpayer Identification Number Certification

ChexSystems is a reporting agency used by financial institutions to track consumer’s deposit account management history. You can request a copy of your Chex Systems, Inc. (ChexSystems) consumer disclosure report by visiting our website at www.chexsystems.com, by voice messaging at 800.428. 9623, by mail at Chex Systems, Inc., ATTN Consumer Relations, 7805 Hudson Road, Suite 100, Woodbury, MN, 55125, or by fax at 602.659.2197

INFIR$T REWARD$ Checking Cash BackApplication

INFIR$T REWARD$ Checking Cash BackApplication

Ownership

Primary Account Owner

Joint Account Owner

Payable on Death Beneficiary

Deposit Information

Taxpayer Identification Number Certification

INFIR$T REWARD$ Checking Cash Back
Application

INFIR$T REWARD$ Checking Cash Back
Application