The Patapsco Bank's Personal Online Banking Enrollment Form
 
 
  *Required Fields
 
  Enrollment Form
 
To sign up for Online Banking. Complete and print the application. Sign the form and send it to The Patapsco Bank via US mail or hand deliver to any Patapsco Bank location. Once the form is returned to us, you will receive a letter within one week containing your login ID and information pertaining to the first time login procedures.
   
  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 #*:  
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.
*Account Number(s):
   
  Signature
 
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.
*Signature: _______________________________________________ *Date: ________________________
    (Today’s Date)
       
*Signature: _______________________________________________ *Date: ________________________
    (Today’s Date)