Business Online Banking New Client Set up Form

Business Online Banking New Client Set Up Form

Business Name:
Business Street Address
City, State & Zip Code
EIN – (Tax ID #)
Contact Person, Title:
Contact Phone:
Contact Email:
For Bank Use:
Port Number:
Account Number / Account Type / Account Nickname / Allow Transfers?
Yes or No
Basic / Bill Pay / Remote
Deposit
Scanning / ACH
File
Origination / Online
Wire
Transfer / Online
Stop Pay

I certify that I am an authorized agent of the company to approve the designated access listed above for this individual. I also understand that the access authority requested for this individual will remain in effect until I notify Community Resource Bank in writing with a request to change or discontinue the access accordingly.

______

Authorized Agent Printed Name Authorized Agent Signature Date

Internal Use: Date:______Data Input by: ______Reviewed by: ______

(03/2016) community-resourcebank.com