Online Bill Pay

Please complete the following information to sign up for Online Bill Pay. This form is secured using 128-bit encryption.

Customer Information:

* Indicates A Required Field

First Name: *
Middle Name:
Last Name: *
Address: *
City, State Zip: *
Home Phone: *
Business Phone:
Social Security Number: *
Date of Birth (MM/DD/YYYY): * / /
E-Mail: *
Confirm E-Mail: *
Primary Account Number: *
Amount of Last Deposit: *
Date of Last Deposit: *

Online Bill Pay Terms and Conditions:

I AUTHORIZE PremierBank to post payment transactions generated by PC from the Bill Payment Service to the account indicated on the form being sent electronically. I understand that I am in full control of my account. If at any time I decide to discontinue service, I will provide written notification to PremierBank. My use of the Bill paying Service signifies that I have read the terms and conditions of the Online Banking Disclosure and Agreement which have been provided to me electronically by the financial institution.

I UNDERSTAND that payments may take 5 - 7 business days to reach the vendor and that they will be sent by check. PremierBank is not liable for any service fees or late charges levied against me.

I UNDERSTAND that I am responsible for any loss or penalty ($) that I may incur due to the lack of sufficient funds or other conditions that may prevent the withdrawl of funds from my account.

DISCLOSURE TO BUSINESS BILL PAY USERS: Your first three months are absolutely free. After that you will be charged $2.95 per month plus 35 cents per bill paid. The charges will be automatically deducted from your checking account.