Business Online Banking Enrollment Form

To sign up for online banking, fill in the information below and press the Submit button.

By submitting this Enrollment Form, I acknowledge that I have read, and confirm that my company agrees to, the terms of the Bank Name Business Online Banking Agreement.

You must be an authorized signer on all business accounts you designate. Upon approval and setup a temporary password will be provided to you to begin using the system.

The first time you log in to Bank Name Business Online Banking, you will be asked to change your password.

Business Information

Business Name Tax ID Number Business Phone Number Business Fax Number

Business Type Sole Proprietor Corporation Partnership LLC Non-Profit Other

Business Type Street Address City State Zip Code Mailing address is different than street address. Mailing address is different than street address. Mailing Address City State Zip Code

Signer Information

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mother's Maiden Name Driver's License Number State Issued Date of Expiration Business Phone Number Business Fax Number E-mail Address Please do NOT email me important news and updates.

Will Signer be an Online User? Yes No

Designated Company Contact (DCC) Information

Is the DCC info different from the signer? Yes No

First Name Last Name Driver's License Number State Issued Date of Expiration Business Phone Number Business Fax Number E-mail Address Please do NOT email me important news and updates.

Requested Cash Management Online Services

In addition to the standard services, which include:

Balance Reporting, Account Detail, View and Export History, Transfer Funds, Stop Payments & Current Check Images

Select any additional services that you may require and a bank representative will contact you to complete the required enrollment process: (Bank approval required from each additional service and fees may apply) Funds Transfers - Domestic Wires ACH - Direct Deposit / Payroll Funds Transfers - International Wires ACH Credits ACH Debits Remote Deposit Capture

Endorsement

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Bank Name to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize Bank Name to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I authorize the Bank to obtain address information from the Department of Motor Vehicles and waive the address confidentiality requirements of the State Vehicle Code. I agree to provide any further information the Bank might require to process my application.

Applicant's Signature Date