Internet Banking Application

Name:_____________________________________________________________________________

Address: ___________________________________________________________________________

City:_____________________________ State:____________________ Zip Code:________________

Social Security #:__________________________ Date of Birth:______________________________

Home Phone:______________________________ Work Phone:______________________________

Primary Account #:____________________________________

E-Mail address:_______________________________________

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)

Customer Signature

_____________________________________________________________________________