Online Banking Enrollment Form

Each submitted enrollment form will be fully verified for accuracy of information. Any inaccurate or incomplete information will cause a delay in online access. Once the verification process is complete, an email will be sent with instructions on how to login for the first time. The process can take 24 to 48 hours. For further assistance, please contact our Online Banking Department at 316-291-5201.
 
*Required Fields
 
Login Information
Please enter your desired User Name. Each User Name must be unique. Your User Name can contain up to 15 characters consisting of letters, numbers and symbols. You may choose any of these 'special' characters`~!@#$%^&*()_+-={}|[]:?;?<>?,./\
Desired Login Name*:
Customer Information
Please provide at least one email address and one phone number to receive your secure access code for your Online Banking login. You will be required to set your password after entering your secure access code.
First Name*:
Middle Initial:
Last Name*:
Business Name (if applicable):
Social Security or TIN#*:
Address*:
Address:
City*:
State*:
Zip Code*:
Primary Phone*:
Work Phone: Ext:
Cell Phone:
Email Address*:
Security Information:
Please fill out this information for security verification
 
Date of Birth (MM/DD/YYYY)*:
Account Number
Please provide the Account Number, Account Type and Access Level for each account that you wish to access using Online Banking. All accounts must have the same ownership as the information provided in Customer Information above.
Account Number* Account Type Access Level Access Level Description

Full Access: View account(s) and make all online transactions including transfers.

View Only: View account(s), NO online transactions.

Signature:
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 Business First Bank.
*Signature: *Date:
  (Type your full name)   (Today's Date)
 
 
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