06/01/09 Version
PERSONAL ENROLLMENT FORM
Sutter Community Bank Connected to OnLine Banking
Name: ____________________________________________ SSN: _________________DOB:____________
Address: _________________________________________City:_______________State:____Zip:___________
Home Phone: ___________________________ Work/Daytime Phone: ________________________________
E-mail Address: ________________________________(Required for Bill Pay)
Accounts to access: ______________, ________________, ________________.
[ ] View Account Balances: View account details, make transfers, enter stop payments & contact us.
[ ] Add Bill Pay:
[ ] E-Statements:
You can pay virtually anyone you
You can view your safe and secure
would normally pay by check or
E-Statement online instead of receiving
automatic debit.
a paper statement in the mail.
Account for Bill Pay: __________________
Desired Username: _________________________ ** (This username will be used to access all of your accounts)
Security Question: ____________________________ Security Answer: ________________________________
By signing below:
I authorize Sutter Community Bank to issue a temporary password.
I recognize that I will be prompted to read & accept the online agreement and privacy policy put forth by Sutter
Community Bank and if I agree to those terms I will be granted access to Sutter Connect.
Signature _____________________________________________ Date: ______________________________
**Each person on the account is required to sign their own individual agreement.
Bank Section: ----------------------------------------------------------------------------------------------------------------------------------
Employee enrolling customer ___________ Verified by: Signature Card ____ Personally Known ____ At account opening ______
Added to Sutter Connect by: __________________Date: _______
Verified by: __________________ Date: _________