The Lyons State Bank Online Banking Enrollment Form
*Required Fields
Login Information
Please select Login-ID between 4-25 characters. It may contain all letters or a combination of letters and numbers, and special characters; it is case-sensitive and cannot contain spaces. Please select a Login-ID that you can remember as you will use this Login-ID once your account is activated.
Desired Login ID*:
Customer Information
Please provide at least one email address and one phone number to receive your secure access code for your Online Banking login. You will be required to set your password after entering your secure access code.
First Name*: Middle Initial: Last Name*:
Business Name:
Social Security/Tax ID #*:    
Address*:  
Address:
City*:   Zip Code*:
Home Phone*: Work Phone:  
Mobile Phone:  
Email Address*:  
Security Information
Please fill out this information section for security verification.
Date of Birth*:  
Mother's Maiden Name*:  
Account Number* Account Type
Please provide the Account Number(s) that you wish to access through Online Banking. All accounts must have the same ownership as the information provided in the Customer Information section above.
Signature and Disclaimers
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*Signature: *Date:
  (Type your full name)   (Today's Date)
        
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The Lyons State Bank
Lyons, KS      © 2011