Online Banking - Application Form

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ONLINE BANKING -
APPLICATION FORM
Please complete and submit the information below. The items are necessary to
verify your identity before permitting access to your financial information. Upon
receipt, we will confirm authorization and contact you to choose a Sign-On ID
and Pass Code.
Please submit this form to your local branch or fax to 304-733-7088
All fields are required.
COMPANY NAME (FOR COMMERCIAL USERS ONLY)
FIRST NAME
MIDDLE INITIAL
LAST NAME
ADDRESS
CITY
STATE
ZIP
EMAIL
TELEPHONE NUMBER
DATE OF BIRTH (mm/dd/yyyy)
MOTHER’S MAIDEN NAME
SIGNATURE
____________________________________________________

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