Business Online Banking Enrollment Form

 


© 2016 First Bank Kansas, All Rights

First Bank Kansas
Business eZBanking Enrollment 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.

Please provide the Account Number and Account Type for each account that you wish to access using Business eZBanking. All accounts must have the same ownership as the information provided in the Business Information section above.

Business Information
Business/DBA Name
Tax ID/EIN
 
Address
City
State
Zip
Business Phone
Business Fax
 
User Information
First Name
Middle Initial
Last Name
 
Date of Birth
Social Security No.
 
Home Phone
Mobile Phone
Work Phone
 
Email Address
Mother’s Maiden Name
 
Driver’s License No.
Driver’s License State
Driver’s License Issue Date
Driver’s License Expiration Date
 
Street Address
City
State
Zip
Login ID Please enter your desired Login ID. Each Login ID must be unique and contain 6-32 characters. It may consist of letters, numbers and/or symbols. Each customer’s Login ID must be unique. If the Login ID you have requested is not available, First Bank Kansas will provide a similar but alternate Login ID for you.
Login ID
 
Account Access Information
ACCOUNT #1
Account Type:

Checking Savings Loan CD/IRA Account Number:
ACCOUNT #2
Account Type:

Checking Savings Loan CD/IRA Account Number:
ACCOUNT #3
Account Type:

Checking Savings Loan CD/IRA Account Number:
ACCOUNT #4
Account Type:

Checking Savings Loan CD/IRA Account Number:
ACCOUNT #5

Account Type:
Checking Savings Loan CD/IRA Account Number:

Additional Comments
 

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

I/We AGREE with the above statement