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UNION STATE BANK - INTERNET BANKING SETUP FORM Offices in Kewaunee, Green Bay and Two Rivers, Wisconsin |
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ONLY ONE SIGNER IS ALLOWED PER AGREEMENT AND LOG-IN ID |
| PERSONAL ACCOUNT | BUSINESS ACCOUNT |
| Name: |
Name: |
| Mother's Maiden Name: |
Authorized Signer: |
| Date of Birth: |
Business TIN: |
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Social Security #: |
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Street, City, State, Zip: |
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EMAIL Address: |
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Log-in ID: (letters, numbers or a combination of both) |
Password: |
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(FOR BANK USE ONLY) |
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*Account Access Choices: |
Access |
Account Number | Account Type |
| FULL: You will have view, deposit and withdrawal access on this account. | |||
| VIEW ONLY: You will be able to view balances, transactions and account history. | |||
| DEPOSIT ONLY: You will be able to transfer funds into this account from other accounts with Full Access. You will not be able to view balance or transaction information. | |||
| VIEW & DEPOSIT: You may view account information and transfer funds into this account. | |||
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*If you want FULL Access to all your accounts with Union State Bank, please write "ALL" under Account Number. All personal accounts under your social security number will have Full access. |
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| * Individuals with both personal accounts and Corporation, Partnership or LLC accounts must complete a separate agreement for access to business accounts. Personal and business accounts will not be available under one agreement. |
| I have received the Internet Banking Agreement & Disclosures on: | |
| Signature: | |||
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Return completed form to: |
UNION STATE BANK PO BOX 337 KEWAUNEE, WI 54216-0337 |
Please DO NOT email this form to us. Email is not a secure way to send confidential information. Please print and mail this form. |
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WE WILL EMAIL YOU A TEMPORARY PASSWORD ONCE WE RECEIVE THIS COMPLETED FORM. |