Account # ______________________________________________

By signing below, I am applying for Personal Branch Banking. I authorize any transactions accomplished through the use of Personal Branch Banking, including the amount of any recurring payment or transfer that I make. I agree to comply with the Personal Branch Banking Agreement and Electronic Funds Transfer Disclosure, as revised from time to time.

I agree that sufficient funds must be available in my account on the date I schedule payments or transfers to be made using the Personal Branch Banking service.

_______________________________________________________
Applicant Signature Date

_______________________________________________________
Co-Applicant Signature Date

If the account(s) designated for this service are joint accounts, both account owners must sign this application.