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Enrollment Form
To sign up for Internet Banking, complete and print the application. Sign the form and send it to Vermillion Bank via US mail, fax or hand deliver to any Vermillion Bank location. Once the form is returned to us, you will receive an email within 48 hours containing your login ID and first time password.
 
First Name:
Last Name:
Address:
City:
State:  Zip: Phone:
E-Mail:
Social Security Number:
Primary Checking Acct. #:
 
Internet Banking
Bill Payment
Access account balances, transfer money, and conduct common banking tasks online for free. Pay bills on-line. Pay any individual or company. Free until further notice.
 
Account Number and Access Type*: Account Description, as you identify this account:  
1)
 
2)
 
3)
 
4)
 
5)
 
6)
 
7)
 
8)
 
* Definitions for Access Types:
  • Full Access - You will have the full access available on this account.
  • View & Deposit - You may view account information and transfer funds into this account.
  • View Only - You will be able to view balances and transactions.
  • Deposit Only - You will be able to transfer funds into this account from other accounts with Full Access. You will not be able to view balance or transaction information.

Please Note: You must be an authorized signer on each of these accounts.

I certify that everything I have stated in this application and on any attachments is correct.  You may keep this application whether or not it is approved.  By typing and submitting this form, I authorize you to check my credit and employment history, to have a consumer credit report prepared on me for the purpose of evaluating this application for credit, and to answer questions others may ask you about my credit record with you.  I understand that I must update this credit information at your request and if my financial condition changes.

Applicant Signature:              Date: 

Joint Applicant Signature:     Date: 

 
To return to the Vermillion Bank web site, click here