To enroll for Online Banking services, please complete and sign this registration form and return it to the bank.
We must receive this signed application before we can process your request.
Social Security number or Tax ID number (of first name on account)________________________
Name on account___________________________________ Account #: _____________
Please print
Address_________________________________________________________________
Please print
Phone #____________________ Alternate Phone #_____________________
List all accounts not associated with primary social security number or Tax ID number that you are authorized to access ______________________________________________________________________
By signing below, I am registering for Internet banking service. I authorize you to charge my account for any transactions made through use of the Internet banking service, including the amount of any recurring payment or transfer that I make. I agree that sufficient funds must be available in my account on the date I schedule payments or transfers to be made using the Internet banking service.
Signature _________________________________________Date _________________
Signature ________________________________________ Date ________________
Your temporary password must be 6 alphanumeric (letters & numbers) characters to set your account up for Teleweb. It must be changed to a permanent password within 48 hours after us notifying you with your temporary password. If you do not change your temporary password, you will be disabled from using Teleweb and will have to contact the bank to set the service up again.
Return this application by mail or in person to the Bank.