Bank Inc.

Enrollment Form

Enter the appropriate data below. After you have filled in the necessary data, press the 'Proceed' button at the bottom of the page to continue to a page where you can verify your data. The 'Cancel' button will send you back to 'Login Page'.

Note: Once you enroll for online banking, you will only be able to view your transactions from the day you are activated in the system as an Internet Banking user. You will not be able to view anything prior to your activation date.

For more information about the fields on this page, click here.

Personal Information

First Name:

Last Name/Company Name:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Social Security Number/Tax ID:

Home Phone:

Work Phone:

Cell Phone:

Alternate Number:

E-Mail 
Address: