BUSINESS ONLINE BANKING ENROLLMENT FORM
To enroll for Alpha Bank & Trust online banking services, please complete this enrollment form, print, sign and return to us via: Fax @ 770-794-5919 Mail @ Alpha Bank & Trust Attn: Online Banking Department 2615 Dallas Highway SW Marietta, GA 30064 Or in person at any of our locations
Customer Information * Business Name: * Company Tax ID Number: * Address: * City: * State: * Zip: * Full Name of Authorized Signer: Daytime phone: * Evening phone: Mobile phone: * E-Mail address: * Date of Birth: Drivers License Number: * Social Security Number: * Account Number:
* indicates a required field
Requested Services Online Banking – Free
Access account balances, transfer money and conduct common banking tasks online.
For security and identification purposes please complete the following: * City of Birth: * County of Birth: * Mother’s Maiden Name: Signature: Date:
By signing or submitting this form, I acknowledge that I have read and agree to the terms and conditions and I authorize Alpha Bank & Trust to issue a temporary password on my behalf, which I must change to a private password of my choosing the first time I log in to Alpha Bank & Trust Online Banking.