Sign Up for Internet Banking
| Please provide us with the information requested below. After you fill out and submit this form,
it will be emailed to the appropriate bank representative via SECURE email. We will call you to confirm your request
for an on-line account during normal business hours, often the same day. |
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IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT.
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial
institutions to obtain, verify, and record information that identifies each person who opens an account.
What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information
that will allow us to identify you. We may also ask to see your driver's
license or other identifying documents.
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By
entering the confirmation codes below, I certify that the information
provided is true and correct. I authorize First State Bank Valliant
to verify the information on this enrollment
form and allow access to all accounts listed above of which I am an
owner. I further certify that I have read the Online Banking Agreement and the Electronic Disclosure, Electronic Signature and Electronic Statements Agreement and
I agree to the terms and conditions thereof.
*REQUIRED Entries
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