NetBanker HTML Application

First & Peoples Bank and Trust Company would like to welcome you to our on-line banking services, NetBanker and ePay. We believe that you will find both of these services a wonderful addition to the products and services already provided to you, our valued customers.

NetBanker is our on-line banking software. Check account balances, view check images, review current and previous statements, transfer funds, make loan payments, all with a click of your mouse.

ePay is our on-line bill payment service. Pay almost any bill with this service by automatically debiting your bank account. No checks to write, no stamps to buy, and no trips to the Post Office. You can set up one time or recurring payments. Pay the easy way, with ePay.

To gain access to these services, simply print and complete this application and return it to one of our offices. We will then assign you with a unique User ID and get you started.

Personal Information

NameBirth DateSocial Security Number
Joint Applicant (if any)Birth DateSocial Security Number
AddressCityStateZip Code
Home PhoneWork PhoneE-mail Address
Home Phone (Joint)Work PhoneE-mail Address


ePay Services
In addition to using NetBanker services, I (we) would also like to sign up for ePay. I (we) understand this service will allow me (us) to pay bills over the internet by directly debiting my (our) designated deposit account(s) with First & Peoples Bank and Trust Company. I (we) understand the recommended lead-time for electronic payments is four business days and ten business days for check payment.


Initials
Initials

____________________I (we) understand and agree to the above terms. Please sign me (us) up for ePay and debit account ____________________.
.
____________________I do not wish to use ePay services at this time.


Security Information
 
Please enter the primary applicant's Mother's Maiden name._________________


Account Information
Please list all accounts that you want to access with NetBanker. This may include checking, savings, Christmas Clubs, CD/IRAs, loans, overdraft protection, and safe deposit boxes. For security purposes, NetBanker does not display account numbers. Each account listed must be given an individual name/description such as “My Checking Account” or “Vacation Fund”.


Account Number
Name/Description of Account
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By signing below, I (we) agree to the following provisions:

  • All account terms and conditions that were disclosed to me at my initial account opening and periodically since account opening still apply to any and all accounts I (we) have requested to access though NetBanker and ePay.
  • I (We) understand that each applicant will be given an individual NetBanker user ID and PIN. Accounts using ePay will also be given a user ID and PIN. I (We) agree not to disclose my (our) PIN(s) to an unauthorized account signer. I (We) also expect the Bank to honor any and all requests made to the Bank using my (our) user ID and PIN.
  • All applicants listed above are authorized to transact business on all accounts listed above.
  • First & Peoples Bank and Trust Company has the right to accept or reject any application.


    ______________________________________________________________
    Applicant's SignatureJoint Applicant's Signature


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    DateFor Internal Use Only


    Rev. 05/2009