INTERNET BANKING ENROLLMENT FORM
311 North Arnold Avenue
Prestonsburg, KY 41653
Phone: 606-886-2321
 Fax Number 606-886-2659
The information received on this Internet Banking Enrollment form will be used exclusively to process the application for Internet Banking Enrollment. Please refer to the Security & Privacy Statement for further information on privacy.

Attention: Please fill out the form on your computer then print it. Sign the bottom of the form and then either fax or mail the form to the fax no. or location provided above. Please close window to return to First Commonwealth Bank.
OWNERSHIP INFORMATION
  Personal
  Commercial
First Name/Company Name
  
Last Name
  
e-mail Address
  
Social Security #/EIN
  
Street Address
  
City, State
 ,  
Zip-Plus 4
-
Home Phone Number  -
Birth Date

Commercial Cash Management and BillPay

 $25/Month


ONLINE BANKING ACCOUNT LIST
Account Number Account Type
Account to be debited for monthly charges and bill payer fees.
Account Number Account Type
By signing below, I agree to accept disclosure notices electronically.
By signing below, I authorize and direct First Commonwealth Bank to set up the above accounts for the Funds Transfer/Bill Payer features on First Commonwealth Bank's Internet Banking System.
First Account holder's signature :

X _______________________________________

Second Account holder's signature :

X _______________________________________

For Bank Use Only
Date Received:_____________ User ID:_______________________________
Approved:_________________ ID/Password Mailed:_____________________
Processed by:__________________________________________________