Southern Heritage Bank

Online Banking or Online Bill Pay Enrollment Form

To sign up for Online Banking or Online Bill Pay, complete and print the application. Sign the form and send it to Southern Heritage Bank via US mail, fax or hand deliver to any Southern Heritage Bank location. Once the form is returned to us, you will receive an email within 48 hours containing your login ID and by United States Postal Service a letter containing your first time password.

First Name:

Last Name:

Address:

City:

State:

Zip: Phone:

E-Mail:

Social Security Number:

Primary Checking Acct. #:

Online Banking

Internet Banking allows you to access account balances, transfer money, and conduct common banking tasks online such as review your statements. This feature is free to all banking customers that enroll.

Online Bill Pay Service
The SHB Bill Pay Option comes with a $4.95 monthly service charge and allows you to use Southern Heritage Bank's Internet Bill Pay Service to process up to 15 online bill payment transactions per month. A per item fee of $0.50 will be charged for additional bill payments over the above mentioned per month.

INTERNET ACCESS TO ALL ACCOUNTS YES _____or NO ____*

INTERNET ACCESS TO ALL ACCOUNTS with BILL PAY ($4.95 PER MONTH) YES ___OR NO ___

* If no then list the accounts you would like Internet Access to:

Account Number and Access Type*:

Account Description, as you identify this account:

* Definitions for Access Types:

ONLINE BANKING: For VIEW ONLY - You will have the access available on this account such as viewing up to date account activity, most recent transactions and transfer funds into this account and out to others.
ONLINE BILL PAY: Includes FULL ACCESS- If your account type does not come with FREE Bill Pay you will have a $4.95 monthly service charge which allows you to process up to 15 online bill payment transactions per month. A per item fee of $0.50 will be charged for additional bill payments over the above mentioned per month.

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

Applicant Signature: Date:

Joint Applicant Signature: Date: