PRODUCTS & SERVICES

Business Account Application

Please complete the fields below. Fields marked with an asterisk ( * ) are required. When you submit the application, you will receive a confirmation screen that reviews the information you have submitted. Please print, sign, and return the confirmation screen in its entirety to us. We cannot process your application until we receive the signed application and initial deposit.
Business Account Information
Business Name*
Federal Employer ID # *
-
Select One*
DBA Partnership Limited Liability Company
Corporation Sole Proprietorship Not-for-Profit Organization
Business Website Address*
Business Purpose*
Mailing Address*
Line 2
City*
State*
Zip Code*
-
County in which this address is located*
Main Email Address to use for statement notifications and other important account updates*
DayTime Phone # *
Date of Incorporation*
State of Incorporation*
 
Authorized Signer Information
Signer 1
First Name
MI
Last Name
Social Security #
--
Date of Birth
Driver's License Number
State
Mailing Address

(Complete if different from business address.)
Line 2
City
State
Zip Code
-
County
Daytime Phone #
ext.
E-Mail Address
Mother's Maiden Name
Yes, I want a VISA Check Card for this signer. (Available with Business Checking Account only.)
Signer 2
First Name
MI
Last Name
Social Security #
--
Date of Birth
Driver's License Number
State
Mailing Address

(Complete if different from business address.)
Line 2
City
State
Zip Code
-
County
Daytime Phone #
ext.
E-Mail Address
Mother's Maiden Name
Yes, I want a VISA Check Card for this signer. (Available with Business Checking Account only.)
Signer 3
First Name
MI
Last Name
Social Security #
--
Date of Birth
Driver's License Number
State
Mailing Address

(Complete if different from business address.)
Line 2
City
State
Zip Code
-
County
Daytime Phone #
ext.
E-Mail Address
Mother's Maiden Name
Yes, I want a VISA Check Card for this signer. (Available with Business Checking Account only.)
Signer 4
First Name
MI
Last Name
Social Security #
--
Date of Birth
Driver's License Number
State
Mailing Address

(Complete if different from business address.)
Line 2
City
State
Zip Code
-
County
Daytime Phone #
ext.
E-Mail Address
Mother's Maiden Name
Yes, I want a VISA Check Card for this signer. (Available with Business Checking Account only.)
 
Account Type & Initial Deposit Amount
Please indicate the type of Business Deposit Application(s) you want to open and the amount of your initial deposit. Minimum deposits of $1,000 are required on CDs. All other accounts are $100 minimum deposit.
Business Checking $ Regular Savings $
Money Market Savings $ 3 Month CD $
6 Month CD $ 12 Month CD $
18 Month CD $ 24 Month CD $
36 Month CD $ 48 Month CD $
60 Month CD $  
Certificates of Deposit Only:
Compound my interest
Mail an interest check each month
 
Initial Deposit Information
Initial Deposit
Deposit Type
If you are making your initial deposit with a check, please make the check payable to First Internet Bank of Indiana.
If you are making your initial deposit with a VISA card, please complete the following fields. Your account will not be charged until your application has been approved. There is a $500 maximum for initial deposits made using a VISA card.
Card Number
Expiration Date
3 Digit Code
The three-digit code can be found following the card number in the signature strip on the back of your credit card.

To send an incoming wire to fund your new First IB account, provide the sending financial institution First Internet Bank of Indiana's routing number (074014187) and note "New Account" in the wire transfer instructions.
 
Expected Account Use
First IB works to combat fraud and protect the confidential information of its customers. One way we do this is by monitoring account activity. Please help us understand your expected use of the account you are opening today so that we know what "normal" activity will be on your account.
How many international wire transfers do you anticipate sending and receiving each year?*
In your current banking relationships, how many cash or check deposits in excess of $5,000 have you made in the past 12 months?*
Does this Business/Organization Cash Checks?*
Does this Business/Organization issue stored value cards?*
Does this Business/Organization issue negotiable instruments (i.e. money orders, travelers checks, cashier's checks, etc)?*
Does this Business/Organization provide financial services?*
Does this Business/Organization currently receive or do you expect to receive payments from credit/debit or stored value cards?*
Does this Business/Organization engage in making or accepting payments related to internet gambling?*
First IB may request periodic updates of this information once your accounts are established. Transaction volumes that are inconsistent with the information you have provided us may result in a block on account activity.
Backup Withholding Certification
TAXPAYER ID NUMBER: The Taxpayer Identification Number shown above (TIN) is the correct identification number.
BACKUP WITHHOLDING: This business is not subject to backup withholding either because it has not been notified that it is subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified this business that it is no longer subject to backup withholding.
 
DISCLOSURES
Government regulations require that we make the following Disclosures available to you when you apply for an account. By clicking on the documents listed below, you may view and print the Disclosures for your records.
Privacy Statement Common Account Fees
Deposit Account Terms & Conditions Electronic Funds Transfer Disclosure
Funds Availability Disclosure Debit Card Agreement
Electronic Wholesale Credit Transactions  

Disclosures*


We cannot open your account unless you check this box.
Statements
Select one* :
The business named on this account intends to receive its statement electronically. I/we understand if I/we later wish to stop receiving electronic statements and instead receive statements by mail, I/we may make this request through the online banking system by following the on-screen instructions.
We prefer to receive a paper statement and understand that we will incur a fee for each paper account statement we receive. (The "account statement" from First IB details the transactions and balances for Business Checking, Regular Savings, and Money Market Savings accounts.)
This application is for a CD only. I/we understand that I/we will not receive periodic account statements from First IB.
 
Online Banking Access
Select one* :
The authorized signer(s) on this account would like access to the account through the online banking system. By checking here, I/we certify that I/we have reviewed and agree to the terms and conditions outlined in the Online Banking Access Agreement.
I/we do not wish to have access to the account through the online banking system at this time. I/we understand that if I/we later wish to access the account through the online banking system that all authorized signers on the account must sign and return the Online Banking Access Agreement to First IB.
 
How Did You Hear About First IB?
How did you hear about First IB?
 
Signature Card

By the signature below, I(we) agree to the terms and conditions of your Business Deposit Application and acknowledge receipt of the applicable disclosures.

I (we) also understand that this is an application for an account with First Internet Bank of Indiana and is subject to approval. In accordance with the USA PATRIOT Act of 2001, First IB may request additional information or documents to be submitted in order to verify my (our) identity prior to opening an account. Every authorized signer listed above and signing below understands and agrees that First Internet Bank of Indiana may verify credit and employment history by any necessary means, including preparation of a credit report by a credit reporting agency.
 
SIGNATURE: I certify under penalties of perjury the statements checked in this section

X____________________________________________________________
Authorized Signer                                                                         Date
Social Security # ______-_____-_______

X____________________________________________________________
Authorized Signer                                                                         Date
Social Security # ______-_____-_______

X____________________________________________________________
Authorized Signer                                                                         Date
Social Security # ______-_____-_______

X___________________________________________________________
Authorized Signer                                                                         Date
Social Security # ______-_____-_______
 
 

Please return this Application with the required forms listed below and initial deposit check to:

First Internet Bank of Indiana
PO Box 80508
Indianapolis, IN 46280

If you are making your initial deposit with a check, please make the check payable to First Internet Bank of Indiana.

If your initial deposit is being made via VISA or Wire, you may fax your signed Application and required forms to: 1-888-644-8678.
Required Forms

Please submit the following with your application so that we may process your application in a timely manner:
 
All Applicants
Please submit copies of your three (3) most recent bank statements
 
DBA/Sole Proprietorships:
Sole Proprietorship Certification
Assumed Name Certificate
Partnerships:
Partnership Resolution
Assumed Name Certificate
 
Limited Liability Companies:
LLC Resolution
Articles of Organization
Operating Agreement
Certificate of Good Standing
Corporations:
Corporate Resolution
Certified Copy of Articles of Incorporation
Certificate of Good Standing
 
Not-for-Profit Organizations:
Corporate Resolution
 
If you have questions regarding this application, please call us toll-free at 1-888-873-3424.