Internet Banking Enrollment Form - 1st National Bank St. Lucia€¦ · Internet Banking Enrollment...

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Internet Banking Enrollment Form

Billing Method: Analysis Charged Waived

Billing Account Number:

Service Option Packages - Choose one Service Option Package and the optional service(s) under each.

Option A – Internet BankingStandard Features: Balance Reporting, Check Images, Secure E-mail and Statements.Optional Features:

Bill Payment Internal TransfersLoan PaymentsStop Payments

Option B – Internet Banking with Wire TransferStandard Features: Balance Reporting, Check Images, Secure E-mail, Statements and Wire Transfer.Optional Features:

Bill Payment Internal TransfersLoan PaymentsPositive PaySpecial ReportsStop Payments

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Internet Banking Enrollment Form - ContinuedPERSONAL INFORMATION

CustomerName:

Phone:

Address: City, State & ZIP:

SSN #: e-Mail Address:

NIC #:

BUSINESS INFORMATIONPrimary BusinessName:

Phone:

Address: Fax:

City, State & ZIP: NIC #:

AgentName:AgentName:AgentName:

ACCOUNT INFORMATIONAccount Number Port Number DDA//SAV/LOAN/COD Short Name ID*

* Short Name Identification: The Short Name Identification is used to help you easily identify your account numbers. As an example, checking account 123456789 could be described as “CHECKING”, or as the actual account number based upon your preference.

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Internet Banking Enrollment Form - ContinuedGENERAL ACCOUNT ACCESS RIGHTS FOR USER

USER NAME: E-MAIL ADDRESS:

SECRET PASSWORD OR PHRASE (Used to identify the user over the telephone):

TELEPHONE NUMBER:

ACCOUNTSHORT NAME/ID

NONECannot access any

account information or perform any transactions.

VIEW ONLYView balances and statements/cannot

perform any transactions.

DEPOSIT ONLYCannot access any account information/deposit funds only.

VIEW/DEPOSITView balances and statements/ability to deposit funds only.

FULLInternal transfer access/perform granted Cash

Management functions.

ADMINISTRATORFull account, Cash

Management access/change user access.

CASH MANAGEMENT TRANSACTION RIGHTS FOR USERCASH MANAGEMENT

FUNCTIONSETUP DRAFT AUTHORIZE DAILY TRANSACTION DOLLAR

LIMITBill PaymentCash ConcentrationControlled DisbursementInternal TransfersLoan PaymentsPositive PaySpecial ReportsWire Transfer*Balance inquiries for Certificates of Deposit are available with ‘View Only’ capability. Statements are available online for checking accounts only. Full or Administrator access to loan accounts allows the user to make loan payments only. Users desiring access to Cash Management functions must have Full or Administrator access to the applicable accounts to perform these functions.

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Internet Banking Enrollment Form - Continued

SPECIAL INSTRUCTIONS

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Internet Banking Enrollment Form - Continued Authorization and Agreement By signing below, I hereby apply for Netteller Service and authorize you and your agents and assigns to provide the Service for the 1st National Bank St. Lucia Limited accounts designated. I understand that the use of the Service is subject to the terms and conditions (including those applicable to electronic fund transfers subject to Regulation E of the Federal Reserve Board) contained in: (a) the Internet Banking Service Agreement ("the Agreement") which I may access when I log onto the Service, and (b) your general disclosure for personal and business accounts which I received when I opened my account(s). I acknowledge and agree that using, or permitting another person to use, the Service confirms the terms and conditions set forth in the Agreement. I must indicate that I wish to cancel the Service by written notice. Non-usage of the Service for two years may result in either termination of the Service or discontinuance of any service fee waiver at our sole discretion. I agree that any time after such notice or period of non-use, you may discontinue both the Service and/or any waiver of charges that ordinarily apply to this or any other services provided by you. If my Service is discontinued, pending payments and recurring payments that have not been sent will be canceled. I hereby certify that all statements in this application are true and complete and are made for the purpose of obtaining the Service; authorize you to obtain such information as you may require concerning the statements herein; agree that this application shall remain your property; and acknowledge my responsibility to inform you of any change in name, address or employment within a reasonable time.

CUSTOMER’S AUTHORIZED SIGNATURE:

DATE:

APPROVING BANK OFFICER’S SIGNATURE: DATE:

FOR BANK USE ONLY BRANCH RESPONSIBILITY CODE:

E-BANKING SETUP COMPLETED BY:

DATE:

E-BANKING SETUP REVIEWED BY: DATE:

KEEP IN A SAFE PLACE OR COMMITT TO MEMORY!

Account Access Information

USER NAME:

PIN:

SECRET PASSWORD OR PHRASE (Used to identify the user over the telephone):

Internet Banking Enrollment Form - 1st National Bank St. Lucia€¦ · Internet Banking Enrollment...

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