Enrollment Form

To sign up for Online Banking, please fill in the information below. If you have a printer, print the enrollment form prior to clicking the submit button because we will need a signed hard copy of the application. You may drop the hard copy off at any of our locations, fax it to 217-245-2010 or mail it to Jacksonville Savings Bank, 1211 W. Morton, Jacksonville, Illinois 62650.

After your application is received, you will receive an e-mail within 24 hours (1 business day) asking how you would like to receive your login information. If you wish to use bill payment, we will add the service as soon as we receive the signed copy of your application. Call 217-245-4111 or e-mail us at info@jacksonvillesavings.com if you have any questions.

Customer Information:

First Name:


Last Name:







 Zip: Phone:



Social Security Number:


Primary Checking Acct. #:


Requested Services:



Internet Banking



Bill Payment


Access account balances, transfer money, and conduct common banking tasks online.


Pay bills on-line. Pay any individual or company. Your first three months are free. After the first three months you may have a monthly service charge depending on the type of checking account you have. Check with customer service for details.


Account Information:

Account Number and Access Type*:

Account Description, as you identify this account:


















*** Definitions for Access Types:

  • Full Access - You will have the full access available on this account.
  • View & Deposit - You may view account information and transfer funds into this account.
  • View Only - You will be able to view balances and transactions.
  • Deposit Only - You will be able to transfer funds into this account from other accounts with Full Access. You will not be able to view balance or transaction information.

**Please Note: You must be an authorized signer on each of these accounts

Sign Here_________________________________________ Date__________