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 application online. Print, sign and return to your local branch.

Account Owner/Signer Information

Name – Owner/Signer               

Name – Business (if applicable)

E-Mail

SSN / TIN

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/business 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 TERMS AND CONDITIONS AGREEMENT

I have reviewed the "Anytime Banking Terms and Conditions Agreement" for 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. I hereby authorize the Bank to charge the primary account indicated above each month for the appropriate fee amount(s) as outlined in the Anytime Banking Terms and Conditions Agreement.

______________________________________

_______________

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.