Internet Banking For Business Application Form
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1Internet Banking for Business Application Form
Thank you for your interest in Internet Banking! Print and complete the enrollment form. Acknowledgment needs to be signed by your
company’s authorized signer(s), in accordance with the existing bank agreement held in our files. Return completed application by mail, or
to your branch. The form will be forwarded to the Bookkeeping Dept. for setup.
Please check one of the following:
N
C
N
I
B
A
E
P
B
P
A
(
I
B
)
EW
NTERNET
ANKING
PPLICATION
HANGE
XISTING
ROFILE
EW
ILL
AY
PPLICATION
MUST BE ENROLLED IN
NTERNET
ANKING
ACH O
R
*
*
(*N
: R
. Y
).
RIGINATION
EMOTE CAPTURE DEPOSIT
OTE
EQUIRES ADDITIONAL INFORMATION
OU WILL BE CONTACTED BY SOMEONE AT THE BANK
Business Information
(required)
__________________________________________________________________________________________
B
N
:
USINESS
AME
_______________________________________________________________________________________
B
A
:
USINESS
DDRESS
(
) __________________________
: _________________________________
B
P
N
:
T
ID/SSN
USINESS
HONE
UMBER
AX
Primary User Information
(required)
Select Single Control or Dual Control in accordance with your company’s authorization. The authorized signers of the company assume full
responsibility for the option that is chosen. Only Contact Persons are authorized to request login ID/password resets and perform online
maintenance. Primary Contact person will be the Company System Administrator.
SINGLE CONTROL
Single Control empowers one Primary User to authorize the creation/modification of Account Control (signing
authority for each account, and one user for the creation/modification of Secondary Users).
DUAL CONTROL
Dual Control requires two (2) Primary Users to authorize the creation/modification of Account Control (this is
the signing authority for each account), and two users for the creation/modification of Secondary Users.
(Requires 2 Primary Users)
The following person(s) is/are herby designated as the Primary User(s) for the purposes and their powers described above. A corporate
resolution, partnership agreement or business certificate appointing the Primary User(s) as duly authorized signer for the Company must be
on file with the bank.
P
C
N
_____________________________________ C
E
:___________________________
RIMARY
ONTACT
AME
OMPANY
MAIL
:
Yes No
View History: Yes No
Stop Payments: Yes No
Pay Bills: Yes No
Transfer Funds
_____________________________________________________ C
: _________________________________________
S
C
N
E
ECONDARY
ONTACT
AME
OMPANY
MAIL
Transfer Funds: Yes No
View History: Yes No
Stop Payments: Yes No
Pay Bills: Yes No
Account List
Account Number
Account Type
Billing Account
You must designate a checking
account as a billing account.
Checking
Savings
CD
IRA
Loan
(check only one)
This account will be your primary Bill
Pay account, and the account to
which any banking fees will be
debited from.
Acknowledgement
(must be signed by an authorized signatory on all of the accounts listed above)
By signing below, you acknowledge receipt of and agree to be bound by all terms of the Agreement and this Internet Banking for
Business Application Form.
_______________________________________ ______________ ___________________________________ _____________
Authorized Signer and Title
Date
Authorized Signer and Title
Date
FOR BANK USE ONLY: Branch Accepting ________________________ Accepted By _____________________ Date _________
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Parent category: Business