Online Banking Enrollment Form

Within 5 to 10 days of receiving this form, you will receive a letter containing your login ID and a separate letter one to two days later containing your temporary password. Use this password, in conjunction with your Login ID, to log into Internet Banking. The first time you log in, you will be forced to change your password. Accounts with more than one authorized account owner will be issued one Login ID and password unless the account owners request separate Login ID’s and passwords for each authorized Internet user.

"*" indicates required fields

Customer Information
Individual #1 - New User
Primary Contact for Accounts
Name*
Individual #2 - New User
Primary Contact for Accounts
Name
Mailing Address
Requested Services
Account Information
Account Number
Account Description (as you identify it)
Type
Flag
 
Account Type: CH=Checking; MMA=Money Market; SAV=Savings; CD=Certificate of Deposit; CP=Checking Plus; LN=Loan

Flag: F=Full Rights; V=View Only (No Transfers Permitted); D=Deposit Only; DV=Deposit and View

(Click + button to add up to 10 accounts)
Additional Access

List all additional users you authorize to utilize online banking and the authority level you desire. Name and address and a separate login ID and password is required for all additional persons you give access to. For account number, ALL is appropriate if you give FULL privileges on ALL accounts. In this case, each person must be an authorized owner of the account(s).
List
User Name
Account Number
View Only
Deposit Only
Full Authorization
 
Place an X in the appropriate box. (Click + button to add up to 5 additional users.)

View Only - May view accounts but has NO authority to request transactions or services.
Deposit Only - May deposit into the account ONLY.
Full Authorization - Provides a user with FULL rights to your account. Person must be an authorized owner of the account.
Authorization*
This field is for validation purposes and should be left unchanged.