Personal Online Banking Enrollment Form

* Denotes required field
Customer Information
Please provide your contact information below, including your e-mail address and phone number to receive your one time secure access code to log in to your account. All information must be verifiable within the Bank's system. There may be a delay in processing your enrollment if information is missing or does not match what we have on file.
First Name*: Middle Initial: Last Name*:
Social Security #*:
City*: Zip Code*:
Home/Cell Phone*: Work Phone:  
Home/Cell Phone:  
Email Address*:  
Security Information

Please fill out this information section for security verification.

Date of Birth*: (MM/DD/YYYY)  
Driver's License or Primary ID Number*:  
Mother's Maiden Name:*  
Date of Last Deposit or Loan Payment:*  
Amount of Last Deposit or Loan Payment*:  
User Name

Please enter your desired Username. Your Username must contain at least 6 characters consisting of at least one letter, numbers and/or symbols.

User Name*
Account Access Information
Please provide the Account Number and Account Type for each account that you wish to access using Online Banking. All accounts must have the same ownership as the information provided in Customer Information above.

Account Number* Account Type

How did you hear about our Online Banking?
Please let us know how you heard about us.
This document is being secured with SSL encryption provided by your browser. Your information will be encrypted when using this form while in transit between your browser and Sturdy Savings Bank. Upon approval you will be notified via e-mail that your application has been accepted and you will be provided with the instructions necessary to complete the "First Time User" login process. During that process you will be presented with your Internet Banking Agreement and Disclosure Statement (Agreement) which you will need to "Accept". You may print a copy to retain for your records.

This Agreement represents all of the terms and conditions agreed to in conjunction with the use of Internet Banking, and includes any other documents or disclosures executed pursuant to this agreement, state or federal law. I agree that I will not release my Username and password to anyone and that it is my responsibility to maintain the confidentiality of my Username and password to prevent unauthorized use. I certify that I am authorized to sign on the accounts listed above. I understand that I am responsible for all charges incurred through the use of this Online Banking and Online Bill Pay Service. I understand that I may incur a fee from my cell phone provider for Internet usage capabilities on my phone. Such fees will be charged as per the agreement with my cell phone provider and not Sturdy Savings Bank.
  Signature*: Date*: