Business Online Banking ACH Services Application

 


© 2016 First Bank Kansas, All Rights

First Bank Kansas
Merchant eZCapture Services Application

Privacy Policy:
Our privacy policy protects the privacy of your personally-identifying information that you provide us online.
The following application is for commercial use ONLY.

Security Notice:
You should ONLY fill out this Application online if you are using a browser with the latest security enhancements. If you don’t have the latest version, download a copy now.
Instructions:
1. Complete Application and click “Submit Application” or fax it to 785-825-7663.
2. To safeguard your privacy, QUIT your browser and restart it again after using this form. This form is NOT saved in your computer’s memory when you quit your browser.

Business Information
Business/DBA Name
 Tax ID/EIN
  
Address
 City
 State
 Zip
Business Phone
 Business Fax
  
Business Purpose
  
Years in Business
 Company Website
  
Business Structure
Corporation
Limited Liability Company
Partnership
Sole Proprietorship
Non-Profit
Municipality
Other
 
Primary Contact Information
Contact Name
  
Email
 Cell Phone
  
ACH File Information
Purpose of File
 Frequency of File
Additional Comments
  

By submitting this application, I agree that First Bank Kansas may use this information to establish an eZBanking ACH account for my business.

I/We AGREE with the above statement