Short Application

USA PATRIOT Act Notice

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 an 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 enter the code to confirm your ability to view the required Portable Document Format (PDF) files. If the code isn't visible, click here to see code in new window or visit your nearest branch to apply for an account.

  We ask that you confirm your ability to download, open, and view the required Portable Document Format (PDF) files. Once you have entered the confirmation code, you may close the PDF document and continue the application process.

  
  

  Click here for your confirmation code.

• Enter code
  OK Error - Please enter the code to verify that you can view the required Portable Document Format (PDF) files. If the code isn't visible you will need to visit your nearest branch to apply for an account.
• Name
  OK Name is required
• Email
  OK Please enter a valid Email address
• Social Security Number
  OK Social Security Number is required

• Is this a joint application?

  • Yes
  • No
  OK Is this a joint application? is required
• Co-Applicant Name
  OK Co-Applicant Name is required
• Co-Applicant Email
  OK Co-Applicant Email is required
• Co-Applicant SSN
  OK Co-Applicant SSN is required

E-Sign Act Disclosure and Consent

• Before proceeding you must confirm that you have read and agree to the terms of the Electronic Signature Act Disclosure available at the link below.
  
• OK
• • I/we confirm that I have read and agree to the terms of the E-SIGN Act Disclosure above. I also agree that the Internet access device(s) I/we will use to receive the related legal disclosures, agreements, online account signature form and the instructions meet(s) the system requirements described in the disclosure presented above; and I/we consent to receiving the related legal disclosures, agreements, online account signature form and the instructions electronically.
  You must read and agree to the terms of the E-Sign Act disclosure. Please make sure that you read it carefully and keep a copy for your records. Please agree to the E-Sign disclosure to continue.
• • By selecting this box I acknowledge that I have read the E-Sign Disclosure
  OK By selecting this box I acknowledge that I have read the E-Sign Disclosure is required

Account Disclosures

Please review the account disclosures and agreements by clicking on the links below. These documents contain the terms and conditions that will apply to your account(s). Once you have read the disclosures and agreements, please click the checkbox to acknowledge you have done so. You have the option to print these disclosures and retain them for your records. If you cannot view the disclosures below, click on the Adobe Reader link above to download the latest version.

• • I/We confirm that I/we have read and agree to the related disclosures above. I/we also agree that the Internet access device(s) I/we will use to receive the related legal disclosures, agreements, online account signature form and the instructions meet(s) the system requirements described in the disclosures aforementioned; and I/we consent to receiving the related legal disclosures, agreements, online account signature form and the instructions electronically.
  OK Please agree to the account disclosures to continue

Additional Information

• Would you like a debit card for this account?

  • Yes
  • No
  OK Would you like a debit card for this account? is required
• For the security of your account, please enter a 4 to 8-digit security code of your choice that we may use to help identify you. Remember to record your security code somewhere safe. If, at any point, you feel that your security code has been compromised you will need to visit a branch in person to have it updated.
  OK For the security of your account, please enter a 4 to 8-digit security code of your choice that we may use to help identify you. Remember to record your security code somewhere safe. If, at any point, you feel that your security code has been compromised you will need to visit a branch in person to have it updated. is required
• For the security of your account, please enter a 4 to 8-digit security code of your choice for your co-applicant that we may use to help identify you. Remember to record your security code somewhere safe. If, at any point, you feel that your security code has been compromised you will need to visit a branch in person to have it updated.
  OK For the security of your account, please enter a 4 to 8-digit security code of your choice for your co-applicant that we may use to help identify you. Remember to record your security code somewhere safe. If, at any point, you feel that your security code has been compromised you will need to visit a branch in person to have it updated. is required

• Occupation Details

  • Employed
  • Unemployed
  • Retired
  • Disabled
  OK Occupation Details is required
• Occupation
  OK Occupation is required
• Previous Role
  OK Previous Role is required
• Date of Employment
  OK Date of Employment is required
• Employer Name
  OK Employer Name is required
• Employer Address
  OK Employer Address is required

• Are you opening a Christmas Club account?

  • Yes
  • No
  OK Are you opening a Christmas Club account? is required
• Deposits to our Christmas Club accounts can be made by scheduled Electronic Fund Transfers (EFT). Please tell us how you want to set up your EFT. Financial Institution Name
  OK Deposits to our Christmas Club accounts can be made by scheduled Electronic Fund Transfers (EFT). Please tell us how you want to set up your EFT. Financial Institution Name is required
• Financial Institution Routing Number
  OK Financial Institution Routing Number is required
• Type of Account CheckingSavings
  OK Type of Account is required
• Name on the Account
  OK Name on the Account is required
• Account Number
  OK Account Number is required
• Amount of Transfer
  OK Amount of Transfer is required
• Frequency of Transfer WeeklyMonthlyBi-WeeklyBi-Monthly
  OK Frequency of Transfer is required
• Start Date (must be at least 1 week from today)
  OK Start Date (must be at least 1 week from today) is required
• End Date
  OK End Date is required
• • The information provided above is correct and I authorize Fidelity Bank to draft funds from the account as detailed above.
  OK The information provided above is correct and I authorize Fidelity Bank to draft funds from the account as detailed above. is required

• Annually, your Christmas Club funds will be electronically transferred to your Fidelity checking or savings account. Please tell us which Fidelity account to use for your annual disbursement.

  • The checking account I’m opening today
  • The savings account I’m opening today
  • My existing checking account
  • My existing savings account
  OK Please make a selection.
• Checking Account Number:
  OK Checking Account Number: is required
• Savings Account Number:
  OK Savings Account Number: is required

• If you are interested in authorizing the Bank to pay overdraft items on ATM and everyday debit card transactions, please view how the overdraft program works as fees apply - Overdraft Authorization. After reviewing how the program works, please make your selection below. This program is only available on Fidelity Premier, On the Geaux, and Prime Senior checking accounts.

  • I DO want Fidelity Bank to authorize and pay overdrafts on my ATM and everyday debit card transactions.
  • I DO NOT want Fidelity Bank to authorize and pay overdrafts on my ATM and everyday debit card transactions.
  OK Please make a selection.

• If you are applying for a new checking or money market account, would you like to order checks? Checking account: 100 Sky Blue Wallet checks for $26 per box. Money Market: 40 Personal Wallet Money Market checks for $20 per box. First box of Premier Checking accounts checks are free.

  • Yes (we will order your checks for you)
  • No (you can order your checks after your account is opened.)
  • I am not applying for a checking or money market account at this time.
  OK Please make a selection.
• How many boxes of checks would you like to order? 1 box2 boxes3 boxes
  OK This field is required.

• We can help you with all of your banking needs. What other products would you like us to contact you about?

  • Fidelity Savings Account. When you are done opening this account, you can open your Savings Account Online.
  • Home Loans
  • Personal Loans
  • Overdraft Line of Credit
  • None
  OK Please make a selection.

• Would you like for us to combine your account statements? Accounts eligible for combined statements include Checking, Savings, Certificates of Deposits and Individual Retirement accounts.

  • Click here if you would like us to combine your statements.
  • Click here if you would not like us to combine your statements.
  OK Would you like for us to combine your account statements? Accounts eligible for combined statements include Checking, Savings, Certificates of Deposits and Individual Retirement accounts. is required

• The Telephone Consumer Protection Act (TCPA) restricts telephone solicitations (telemarketing) and the use of automated dialing systems, artificial or prerecorded voice messages, SMS test messages, and fax machines when marketing to consumers. By selecting I Consent below you are authorizing Fidelity Bank to contact you by telephone for marketing purposes. Consumers who ask not to receive telephone solicitations from Fidelity Bank will be placed on the banks Do Not Call list and will not be called in any future campaigns.

  • I Consent to receive marketing, advertising and similar communications from Fidelity Bank or NOLA Lending at the phone numbers listed below.
  • I do not Consent to receive marketing, advertising and similar communications from Fidelity Bank or NOLA Lending.
  OK The Telephone Consumer Protection Act (TCPA) restricts telephone solicitations (telemarketing) and the use of automated dialing systems, artificial or prerecorded voice messages, SMS test messages, and fax machines when marketing to consumers. By selecting I Consent below you are authorizing Fidelity Bank to contact you by telephone for marketing purposes. Consumers who ask not to receive telephone solicitations from Fidelity Bank will be placed on the banks Do Not Call list and will not be called in any future campaigns. is required
• Land Line Number
  OK Land Line Number is required
• Mobile Number
  
  By adding a mobile telephone number I am certifying that I am the account holder for the mobile telephone account or I have the permission from the account holder to use the mobile telephone number. I understand that standard data and messaging rates may apply based on the plan with the mobile telephone carrier. (Mobile Number is optional)
  (Mobile Number is optional) OK Mobile Number
  
  By adding a mobile telephone number I am certifying that I am the account holder for the mobile telephone account or I have the permission from the account holder to use the mobile telephone number. I understand that standard data and messaging rates may apply based on the plan with the mobile telephone carrier. (Mobile Number is optional) is required

Opening Deposit

• How do you want to fund this account?

  • From my existing Fidelity Bank account.
  • From another financial institution account. (It may take up to 4 business days to process your initial deposit.)
  • Please contact me to discuss.
  OK How do you want to fund this account? is required
• Last 4 digits of account number:
  OK Last 4 digits of account number: is required
• Initial deposit amount:
  OK Initial deposit amount: is required
• Financial Institution Name:
  OK Financial Institution Name: is required
• Financial Institution Routing Number:
  OK Financial Institution Routing Number: is required
• Account Type: CheckingSavings
  OK Account Type: is required
• Name on the Account:
  OK Name on the Account: is required
• Account Number:
  OK Account Number: is required
• Initial deposit amount:
  OK Initial deposit amount: is required
• • If you provide your contact information you authorize Fidelity Bank or its affiliates to contact you. Your authorization allows us to use text messaging and automatic telephone dialing systems in connection with calls made to any telephone number you provide, even if the telephone number is assigned to a cellular or mobile telephone service or other service for which the called party is charged. You may contact us anytime to change these preferences.
  OK If you provide your contact information you authorize Fidelity Bank or its affiliates to contact you. Your authorization allows us to use text messaging and automatic telephone dialing systems in connection with calls made to any telephone number you provide, even if the telephone number is assigned to a cellular or mobile telephone service or other service for which the called party is charged. You may contact us anytime to change these preferences. is required
• • By selecting this box I acknowledge that I am not under the age of 13 and approve submission of this information.
  OK By selecting this box I acknowledge that I am not under the age of 13 and approve submission of this information. is required