PLANTERS BANK TRUST COMPANY INTERNET BANKING ENROLLMENT FORM

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					                                              PLANTERS BANK & TRUST COMPANY
                                            INTERNET BANKING ENROLLMENT FORM
                                                                   CONTACT INFORMATION:
Name:
Address:                                                                                                        TIN/SSN:              -     -

City:                                                                               State:                      Zip:            -

Phone:                -       -                         Primary Contact for Account(s):

Email Address:
                                  When filling out this form, fill out either the Basic Section or the Advanced Section
                                                          BASIC ON-LINE BANKING
               Basic services include: Free Access to your accounts, unlimited transfers, view statements, account history download,
                                                        On-Line Bill-Pay, re-order checks,
                              Account Type:         CH = Checking          MMA = Money Market         SAV = Savings      LN = Loan

    User # - Name                  Account Number                   Type                        User # - Name          Account Number                     Type

TIN / SSN                          545455545                         CH                    TIN / SSN                   545455545                          CH




                                                      ADVANCED ON-LINE BANKING
                 Advanced Services include all Basic Services plus Payroll, Tax Payments, Wire Transfers, and ACH transactions.
                                                          CHARGES (Bank Use Only)
Charge to account:                                           Monthly Charge:     20.00       Payroll Items:   0.10     Tax Item Charge:            1.00

Wire Items:                  10.00        ACH Items:        0.10
                                                   USER INFORMATION: ACCESSIBLE ACCOUNTS
                                                                                     Rights available
Account Type:             CH = Checking       MMA = Money Market           SAV = Savings      RLOC = Revolving Line of Credit       I L = Installment Loan
                                                                    Type        Payroll        EFT Tax            Wire              ACH             View
                                                                                               Payments         Transfers                           Only
    User # - Name                  Account Number                                    (If View Only is selected, no other access may be set.)
Example: JLONG                     545455545                         CH




                                              BANK INFORMATION (To Be Completed By Bank)
   New        Date:                   Existing, since          Officer:            Branch:

SIGNATURES: By signing below, I hereby authorize THE BANK to issue a temporary password for my account which must be changed upon first
entry into the system. Customer understands that Cash Management can only be accessed by the FIRST computer used to log in. Customer can
change which computer has Cash Management access by contacting the bank representative in charge of Customer’s Cash Management
accounts.

                      Signature                                     Date                                 Signature                                Date
                        For additional users and/or accounts
User   Account Number         Type   Payroll   EFT Tax           Wire      ACH   View
 #                                             Payments        Transfers         Only