SCREEN PRINT AND COMPLETE
FORM AND TAKE COMPLETED FORM TO THE BANK OF
INSTRUCTIONS.
ONLINE BANKING ENROLLMENT FORM
Customer’s Name:_________________________________________________
Address:__________________________________________________________
Phone (Home &
Work):_____________________________________________
E-Mail Address:____________________________________________________
(Required for Bill Payment)
Social Security Number:____________________________________________
Date of Birth:_______________________________________________________
Account
Number(s):_________________________________________________
Port Number (Bank
Use):____________________________________________
Bill Payment
(Optional):_____________________________________________
I HAVE READ AND ACCEPT THE
TERMS OF BANK OF
Customer’s Signature:_______________________________________________
Date:________________________________________________________________