Enterprise Online Banking Enrollment Form
THIS FORM IS TO BE USED BY PERSONAL ACCOUNT HOLDERS ONLY. COMMERCIAL CLIENTS SHOULD CONTACT THEIR RELATIONSHIP MANAGER TO ENROLL IN ONLINE BANKING.
*Required Fields
Login Information
Please select Login-ID between 5-15 characters. It may contain all letters or a combination of letters and numbers; it 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 Name*:
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*:
Social Security #*:    
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*:  
Amount of Last Deposit*:  
Account Number* Account Type Access Level Access Level Description

Full Access: View account(s) and make all online transactions including transfers.

View Only: View account(s), NO online transactions.

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 above.
Do you want access to BillPay? *     Yes  No
Signature and Disclaimers
It is the user's responsibility to promptly review all account information and notify Enterprise Bank & Trust at (800) 438-0378 if any errors are present. By signing below, you are authorizing Enterprise Bank & Trust to issue a log-in ID and temporary access code on your behalf. Confidentiality of the log-in ID and password will be the responsibility of each individual user.
*Signature: *Date:
  (Type your full name)   (Today’s Date)
        

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