Personal 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*:
Customer 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.
First Name*: Middle Initial: Last Name*:
Social Security #*: Date of Birth:*
City*: State*: Zip Code*:
Home Phone*: Work Phone:
Mobile Phone:
Email Address*: Bank Use Only:
Mother's Maiden Name OR Security Word  
 NOTE: If you do not have a security word established at this time, please stop by one of our offices to set one up.
Ending balance of most recent statement   
 NOTE: For security reasons, if this information does not verify with the Bank records, we will not be able to process your    Internet Banking registration.
Amount of last debit, withdrawal, or opening deposit.   
 NOTE: Registrations with $0 in both monetary fields will not be processed for security purposes.
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.