Small Business Online Banking Enrollment
*Indicates Required Fields
 
Customer Information
Please provide at least one email address and one phone number to receive a secure access code for your Online Banking login. You will be required to set your password after entering your secure access code.
 

Business Name [as it appears on the accounts(s)]:

*First Name:

Middle Initial:

*Last Name:

Authorized Signer Name:

Title:

*Business Address:

Address

*City:

*State:

*Zip Code:

*Employer Identification Number:

*Drivers License #:

*Date of Birth:

*Home Phone:

Work Phone:

Mobile Phone:

*Email Address:

 
Secure Access Information
A unique secure access code is required to register your computer and when you have forgotten your password. Secure Access Codes can be delivered by email, voice by phone (or cell), and/or text by cell phone. Please provide the phone number and/or Email address that your secure access code should be delivered to.

Delivery Method:
Email Address or Phone Number:
 
Voice
Text
Email
Voice
Text
Email
Voice
Text
Email
Voice
Text
Email


Access to the following account(s), if you have more than four accounts, please call 800.460.6634 or visit a branch:

Account Type:
Account Number(s):
 
Checking
Savings
CD
Loan
Checking
Savings
CD
Loan
Checking
Savings
CD
Loan
Checking
Savings
CD
Loan
 
 
Signature & Disclosures:
This document is being secured with SSL encryption provided by your browser. Your information will be encrypted when using this form while in transit between your browser and Independent Bank.
 
*Signature:
*Date:
(Type your full name)
(Today's Date)