Family of Banks Online Banking Enrollment Form
 
Please use the following form to enroll in Online Banking. If you have any questions, you may call us at 406-532-8000.
 
*Required Fields
 
Login Information
 
Choose your Online Banking login name. Must be at least 5 characters and cannot be more than 15 characters.
Desired Login Name*:
 
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 create a password after entering your secure access code.
First Name*: Middle Initial: Last Name*:
Social Security #*:  
Address*:  
Address:
City*: State*: Zip Code*:
Home Phone*: Work Phone:  
Mobile Phone:  
Email Address*: Bank Use Only:
 
Account Access Information
 
Please provide the Account Number(s) that you wish to access through Online Banking. All accounts must have the same ownership as the information provided in the Customer Information above. These accounts will also be enrolled for Online Banking paperless statements.
*Account Number(s):
 
Signature & Disclosures:
 
This document is being secured with SSL encryption provided by your browser. Your information will be encrypted when using this form while in transit between your browser and Bitterroot Valley Bank.
*Signature: *Date:
  (Type your full name)   (Today’s Date)