ExpressWEB Online Banking Application

To apply for online banking services, complete the New User
Application, print, sign and return to:

F&M BANK
Attn:  Bookkeeping Dept
P. O. Box 1130
50 Franklin St.
Clarksville, TN 37040

Yes! I want instant access to my personal finances!
Once your application is received and approved by F&M Bank, you will receive your access ID and password. The first time you access your account, you will be required to change your password. If you believe the security of your access ID or password has been compromised, promptly notify us.

On-Line Banking (ebanking)-Customer Information

Customer Name  

Street Address

City State Zip

Mother's Maiden Name  

Social Security #   Date of Birth

Home Phone Business Phone

*E-mail Address

*Must have this information to establish On-Line Banking (ebanking) access.

On-Line Banking (ebanking)-Services Requested

Sign me up for F&M On-Line Banking (ebanking) I also want the convenience of ExpressWEB online Bill Pay

On-Line Banking (ebanking)-Account Information (Ownership of accounts)

Account Number

Account Type
Checking Savings CD's Loan
Checking Savings CD's Loan
Checking Savings CD's Loan
Checking Savings CD's Loan

By signing my name or initials in the space provided following this sentence, I hereby acknowledge that it is my wish to receive future disclosures and notification of changes to the terms and conditions via my email address noted above. ___________________________________________________

Set-Up Request Cannot Be Processed Without Customer's Authorization Signature

By signing below, I hereby make application for F&M On-Line Banking (ebanking) Services. I agree to comply with F&M Bank Online Banking (ebanking) Terms and Conditions and Disclosure and Bill Payment Service Terms and Conditions which I agree govern my account. I agree to all terms and conditions provided herein, which may be changed from time to time by the Bank in the manner provided herein. My use of On-Line Banking Bill Payment Service signifies that I have read and accepted all the terms and conditions of the service including those referenced above.

Customer Signature_____________________________________ Date____________

For Bank Use Only

Submitted by:______________________________________ Date _________

D.A.I.R. Maintenance by:_____________________________ Date _________

CONNECT3 Maintenance by:__________________________ Date _________

Verified By: ________________________________________ Date _________

 
 

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