Online Banking Form
Internet Banking Application
City:_____________________________ State:____________________ Zip Code:________________
Social Security #:__________________________ Date of Birth:______________________________
Home Phone:______________________________ Work Phone:______________________________
Primary Account #:____________________________________
PERSONAL INDENTIFICATION NUMBER (PIN)
Each individual who is to have access to Butte State Bank Online Banking must designate a 4-digit Personal Identification Number (PIN), please enter it below. Once you have logged on to Butte State Bank Online Banking, the software will allow you to establish your 6-character online password.
PIN ___ ___ ___ ___
Mother’s Maiden Name:_________________________________________
(This information will be used to help enhance the security of your account information. It will help us verify your identity, should you need assistance over the telephone at some future time.)
By signing below, customer agrees to the terms and conditions set forth for Butte State Bank Online Banking and acknowledges that only the individual whose signature appears within is authorized to use Butte State Bank Online Services.
(Print off and mail to PO Box 28 Butte NE, 68722 or PO Box 266 Spencer, NE 68777)