Anytime Banking Enrollment Form

MEMBER FDIC

NOTE: Must be a State Bank of Cochran, First Laurens Bank or Community Bank of Johnson County customer to apply. Please complete the enrollment form online. Print, sign and return to your local branch for approval.

Account Owner/Signer Information

Name – Owner/Signer           

SSN/TIN

Web Bill Pay  Yes  No

E-Mail

Account Information

Please provide the Account Type and the Account Number for each account that will be accessed using Anytime Banking. Please note: The individual indicated above must be an owner/signer on all accounts.

1.  Checking Savings  CD Loan

4. Checking Savings CD Loan

Primary Account #:

Account #:

2.   Checking Savings CD Loan

5. Checking Savings CD Loan

Account #:

Account #:

3. Checking Savings CD Loan

6. Checking Savings CD Loan

Account #:

Account #:

ANYTIME BANKING AND WEB BILL PAY TERMS AND CONDITIONS AGREEMENT

I have reviewed the "Anytime Banking Terms and Conditions Agreement" for the State Bank of Cochran, First Laurens Bank and Community Bank of Johnson County ("Bank") Anytime Banking Service and accept such Anytime Banking Terms and Conditions Agreement. By using the online financial services provided by the Bank, I agree to abide by the terms and conditions of this agreement and the Web Bill Pay Terms and Conditions.  I hereby authorize the Bank to charge the primary account indicated above for the appropriate fee amount(s) as outlined in the Anytime Banking Terms and Conditions Agreement and the Web Bill Pay Terms and Conditions.  By signing below, I agree that all information is accurate, and I authorize the Bank to verify credit and employment history by any necessary means, including preparation of a credit report by a credit reporting agency.

______________________________________

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Signature

 Date

Return Application to State Bank of Cochran, First Laurens Bank or Community Bank of Johnson County.
MEMBER FDIC

Upon receipt of completed application, an Anytime Banking Welcome EMail will be sent to the email address above. This email will include your first time log on instructions and Access ID and temporary Password.