STRATEGIC CAPITAL BANK

CAPITAL ACCESS ONLINE BANKING

Use this form to enroll for Online Banking and Online Bill Payment

Section 1 - Customer Information

Note: each account holder must complete a separate enrollment form and will receive an individual customer ID number.

First Name: MI:  
Last Name:  
Street Address:
City:  
State:     ZIP:  
Social Security Number - -  
Home Phone: () -    
Work Phone: () -  
Email Address:
 

Section 2 - Account Access

You may access any or all of your bank accounts and loans, and you may choose a "pseudo name" to identify the accounts (since your account number is never shown on any online banking screen.) Please list below the accounts you would like to access through online banking, and what you would like to call each account (i.e. "household checking" or "college savings".)

Account Number Type of Acct.
(Checking, Loan, C.D.)		 Pseudo Name
Checking Loan C.D.
Checking Loan C.D.
Checking Loan C.D.

If you would like access to additional accounts that are not registered in your name, on which you are a co-owner, authorized signer, or otherwise have authority to transact business, please list below:

Account Number Type of Acct.
(Checking, Loan, C.D.)		 Pseudo Name
Checking Loan C.D.
Checking Loan C.D.

Section 3 - Online Bill Payment Option

Online Bill Payment is not rquired for enrollment in Capital Access Online Banking. A separate Customer ID number and security code will be issued for initial access to Online Bill Payment.

Include Bill Payment Option with my enrollment
Add Online Bill Payment to my existing Capital Access banking services

Primary Checking Account:
Please designate a checking account number that will be used for bill pay services.

Checking Account Number:
If you wish, you may add another name to your online bill payment account. For example, this would be useful if you wanted to pay a bill which is in your spouse's name.

First Name:     MI:     Last Name:

Section 4 - Signature

I hereby authorize Strategic Capital Bank to establish online banking services and to provide access to the account(s) listed above. I agree to safeguard my "personal identification number" (PIN), and to notify the bank immediately if I have reason to believe the security of my account(s) has been compromised in any way. All instructions delivered via Capital Access Online Banking will be deemed to be my written authorization to charge or credit my account for transactions indicated. All such transactions are subject to Strategic Capital Bank's Deposit Account Terms and Conditions. I agree that Strategic Capital Bank may electronically deliver any notices and disclosures required by law.

Printed Name: ___________________________________________     Date: ________________
Signature: ______________________________________________     Date: ________________
 


 

Please print and return your signed enrollment form to Strategic Capital:

Mail To:
Strategic Capital Bank
Online Banking
1608 Broadmoor Dr.
Champaign, IL 61821		 Fax To:
ATTN: Online Banking
(217) 398-1661