Civis Bank
P.O. Box 550, Rogersville, TN  37857
Phone 423-921-9900     Fax 423-272-5296

Internet Banking Application

Name:

Address:

City:

State:

Zip:

SSN:

Daytime Phone:

Email:

Mother's Maiden Name:

 

Please sign me up for Civis Bank Internet Banking.  I understand there is no charge for

balance inquiries and transfers as well as no charge for the first 15 transactions per

calendar month with Civis Bank BillPay and a $.50 charge per BillPay transaction thereafter.

 

Operating System:
Windows XP/Vista
Windows 7
Windows 8 or 8.1
Macintosh OSX 10.7+
Other  

Internet Browser:
Internet Explorer 9+
Firefox
Safari 6+
Other
Don't Know

Signature ______________________________________    Date ___________

Upon receipt of your signed application, instructions for accessing your account online will be mailed to you within 7 days.

 

Print This Page

 

This form can only be processed with your signature. Use one form for each individual.
Enter the information in the application online, print, sign and return to Civis Bank
.


 

For Internal Bank Use:

 

Name: _____________________________________  SSN: _________________________

 

 

Received by:________ Date__________  Created by:________ Date __________  Changed by ________ Date __________

 

_______________________      Comment _________________________

Assigned Access ID