Business Online Banking Enrollment Form *Required Fields Login Information Your Login Name must be between 8 and 12 characters long. The user ID must be unique to our system. Your Password must be between 6 and 45 characters and contain at least one special character, one upper case letter, and one lower case letter. Desired Login Name*: Temporary Password*:   Applicant Information Please provide at least one email address and one phone number to receive your secure access code for your Online Banking login. You will be required to set your password after entering your secure access code. Business Name:*   Contact Person's Information First Name: Middle Initial: Last Name: Business Tax ID*: Address*: Address: City*: State*: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code*: Work Phone*: Mobile Phone: Email Address*: Bank Use Only:   Additional Access Requested*         Bill Pay Access        Please Select Yes No   Mobile Access        Please Select Yes No     Signature & Disclosures: By clicking Submit Enrollment below, I certify that everything I have stated in this enrollment is correct. I authorize First National Bank of Jeanerette to contact me. Thank you for submitting your First National Bank of Jeanerette online enrollment form. You will receive a confirmation email with log-on instructions within two business days. Please do not attempt to log on until we have contacted you by email.