Enrollment Form
First Name:
Last Name:
Business Name:
Address:
City:
State:  Zip: Phone:
E-Mail:
Social Security Number:
Date of Birth:
Primary Checking Acct. #:
 
Internet Banking
Bill Payment
Access account balances, transfer money, and conduct common banking tasks online Pay bills on-line. Pay any individual or company.
 
Account Number and Access Type*: Account Description, as you identify this account:  
1)
 
2)
 
3)
 
4)
 
5)
 
6)
 
7)
 
8)
 
* 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.

 
I certify that everything I have stated in this application is correct and that I am an authorized signer on the account.

Applicant Signature:              Date: 

Joint Applicant Signature:     Date: 

A signed application is needed to complete the enrollment process. Please print and sign this form, and deliver to Security State Bank in one of the following ways:

  • Mail:
  • Security State Bank
    Attn: Internet Banking Enrollment
    P.O. Box 1050
    Centralia, WA 98531

  • Fax:
  • Security State Bank
    Attn: Internet Banking Enrollment
    360.330.8422

  • Drop off at any Security State Bank location.
Once the form is returned us, you will receive your login ID and first time password via email.