Personal
Banking Enrollment Application This application
is to be completed and mailed to: Jefferson Bank Internet Banking Department 18333
Preston Rd. Suite 100 Dallas, TX 75252
Please
Select the Appropriate Box
First
Name: M.I.
Last Name:
Street
Address:
City/Town:
State:
Zip Code:
Daytime
Telephone: Evening Telephone:
Email
Address : Temporary Password:
**
**The
Internet Banking system will require you change your password the first time you
access your Online Banking account. Temporary passwords should be 6 to 8 characters.
Please
list all accounts that you are a signer on and would like to be able to have internet
access to. Also list a descriptive name you would like to use for each account
you have selected. (Example of account descriptive names you might like to use:
Sam's checking, Sara's savings, truck loan, home loan, etc..) No more than 20
characters can be used including blanks. Do not repeat account descriptive names
or use special characters (ex: %, &, *, $, @, etc.).
Account
Number
Descriptive
Name
PLEASE
READ BEFORE SIGNING I (we) certify that the information provided is true
and correct. I (we) authorize Jefferson Bank to verify any information included
in this application and allow me (us) access to all the accounts listed above.
The use of Jefferson Bank Internet Banking shall be governed by the printed terms
and conditions of the Jefferson Bank Internet Banking agreement and disclosures
and such other terms and conditions or amendments thereto, as may be established
by Jefferson Bank and communicated in writing to me (us). I (we) hereby authorize
Jefferson Bank to set up the transfer grouping listed above. I (we) understand
that the account numbers are set up as a related group and that I (we) can transfer
to/from all numbers in that grouping, as capabilities and/or restrictions allow. The
undersigned agrees to the same terms stated above,
