Open a Deposit Account
Application Form
 
Please fill out the following form, print it and mail it with a copy of the
driver's license / government issued photo ID for everyone on the account and your initial deposit to:
First Federal Bank
601 Clinton, P.O. BOX 248
Defiance, Ohio 43512
 
Account Ownership:
Type of Account:
1. Free Checking
2. Free Plus Checking
3. Merit Checking
4. Premium Checking
5. Classic Money Market Account
6. Savings
7. Certificate of Deposit
 Term (Enter Months)
 
Date:
Name:
Are you an existing First Federal Customer? Yes No
E-Mail Address:
Drivers License /
Gov't. Issued Photo ID Number:
Drivers License /
Gov't Issued ID Exp Date:
Address:
City
State:
ZIP Code:
Home Phone:
Work Phone:
Date of Birth:
Social Security Number:
Amount of Deposit:
 
Signature:
 
___________________________________________________________________________

 

If Joint:  
Name:
Drivers License /
Gov't. Issued Photo ID Number:
Drivers License /
Gov't. Issued Photo ID Exp Date:
Address:
City:
State:
ZIP Code:
Home Phone:
Work Phone:
Date of Birth:
Social Security Number:
   
Second Signature:
 
___________________________________________________________________________
 

BACKUP WITHHOLDING CERTIFICATIONS:
 
TIN: ________________________________________
 
TAXPAYER I.D. NUMBER - The Taxpayer Identification Number shown above (TIN) is my correct taxpayer identification number
 
BACKUP WITHHOLDING - I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest of dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding.
 
EXEMPT RECIPIENTS - I am an exempt recipient under the Internal Revenue Service Regulations.
 
NONRESIDENT ALIENS - I am not a United States person, or if I am an individual, I am neither a citizen nor a resident of the United States.
 
Truth In Savings
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Privacy Statement Please enter a 4 digit number to let us know that you have reviewed the Privacy Statement.
 
Affiliate Marketing Disclosure Please enter a 4 digit number to let us know that you have reviewed the Affiliate Marketing Disclosure.
 
SIGNATURE:  I certify under penalties of perjury the statements checked in this section.
 
___________________________________________________________________________
(DATE)
Remember to send copies of drivers licenses / government issued photo IDs for everyone on the account.