Business Online Banking Enrollment

Disclosure and Policy Sign-Off

Please click each item to read and then verify your agreement to the following:

Online Disclosure

Business Information

Business Name:

Address:

City:

State:

Zip:

Business EIN #:

Senior Admin Information

Business Owner or Member of Executive Management

This is the Business Owner or Member of Executive Management according to bank documents. This role provides full online access rights including adding/changing additional users/accounts. (Documents may need updated prior to processing.)

Contact Name:

Contact Phone:

Email Address:

Requested Access ID: (Must be at least 8 characters, Case Sensitive, may not contain spaces, #, !, or ^)

Business Contact Information

Business Owner or Member of Executive Management

This is the Business Owner or Member of Executive Management according to bank documents. (Documents may need updated prior to processing.)

Contact Name:

Contact Phone:

Email Address:

Additional Features Requested

ACH/Direct Deposit

ACH Services – The ability to send out payroll, pay vendors, collect payments and move company funds between banks from the convenience of your desktop.

Yes

Wires

Online Wire Service – The ability to send domestic and international wires from the convenience of your desktop.

Yes

Account Information

Account Number	Account Type	Nickname	E-Statements	Bill Pay
			Yes No	Yes No

Additional Online Banking Users

Name	Contact Phone	Email Address

Access ID:	Role:	Bill Pay: Yes No
Account Number(s) to be Assigned (Separate Numbers with Commas)

Do you wish to add additional users? Yes No