BankOnLine Application

Please fill out this secure form. Sign, Date, provide your Driver License Number, Print, and bring to the nearest CBBC location.
Name: 
Social Security No.: 
Address: 
City: 
State: 
Zip: 
Day Phone: 
Evening Phone: 
E-mail Address: 
   
Name: 
Social Security No.: 
Address: 
City: 
State: 
Zip: 
Day Phone: 
Evening Phone: 
   

For confidentiality reasons your account numbers will not be provided over the Internet. Below, please list the accounts to which you would like to have BankOnLine access and create a descriptive name for your reference.

I would like BankOnLine access to the following accounts of which I am an authorized signer:

 
*Use up to 20 characters (do not use punctuation, but spaces can be used) to identify your accounts. These names can be changed in BankOnLine once you are signed on.
 
 

I authorize CBBC to post payment transactions generated through Express Bill Pay to the account indicated. I understand that payments will be sent either electronically or by check. Payments made by check may take up to 10 days to reach the vendor. CBBC is not liable for any service fee or late charges levied against me, unless they are found to be at fault. I also understand that I am responsible for any loss or penalty that I may incur due to lack of sufficient funds or other conditions that may prevent the withdrawal of funds from my account. I understand that I am in full control of my account. If at any time I decide to discontinue this service, I will provide written notification to CBBC. My use of Express Bill Pay signifies that I have read and accepted all the terms and conditions of Express Bill Pay.

I understand that account security is controlled by my BankOnLine ID and PIN, initially assigned by CBBC. Once I am signed on I can change both my ID and PIN at my discretion. I agree to protect the confidentiality of my Bill Pay ID and PIN.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT
To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

 

Signature   ____________________   Date  _________  Driver License Number  ____________