American National Bank Electronic Banking Services Application

To get started with American National Bank TeleWeb, simply print, complete, sign, and return the enrollment form today.
You may either mail the completed and signed application to the address below, or drop it off at one of our branch locations:
American National Bank,   Attn: Customer Service,  PO Box 5009,  Ardmore, Ok.   73403

System Requirements:  Connection to the Internet
Applicant Information:

Applicant:  _______________________________________________________

Co-Applicant :  ____________________________________________________

Address1:  _______________________________________________________

Address2:  _______________________________________________________

Email Address: _____________________________________________

  City: __________________________

 State: __________________________
   ZIP: __________________________
Applicant SSN: ___________________ Home Phone: _____________________
Co-Applicant SSN: ________________ Work Phone: _____________________

Bank Information:
Checking Account Number:
_____________________

 Electronic Banking Fees:

No fees at this time.
____  Consumer Account ____ Commercial Account

I/we hereby authorize American National Bank to process transactions as requested through the American National Bank  Electronic Banking Service, including transfers and loan payments. I/we agree that my/our first use of the Service will signify our acceptance of the American National Bank Electronic Banking Agreement.  I/we also authorize American National Bank to use credit reports in connection with this application to verify credit standing.

Signature:______________________________________   Date:__________________

Signature:______________________________________   Date:__________________


Affiliated Customers:

1.   I / We authorize the TeleWeb customer named above, in the applicant section, to have access to all of my bank accounts accessible through the TeleWeb service via the Internet.       Yes _____   No _____  (please mark the appropriate response)


2.  If yes, what is your primary social security number on the accounts you wish to provide access?

___________________

3.  Do you want the individual/individuals named in the above applicant section of this form to have the ability to make transfers and payments to and from your accounts?   Yes ______   No _____  (please mark the appropriate response)

I understand by answering yes to the above question number (1)that I am authorizing the individual or individuals named above, in the applicant section, access to all of my financial information accessible through the TeleWeb Service.  I also understand that by answering yes to the above question number (3) that I am authorizing the same individual or individuals named above the ability to make my loan payments and transfer funds into or out of my accounts. It is also known by me that funds transferred from my account can be transferred to accounts not owned by me by the above mentioned individual or individuals.

 

All account owners must sign and date below to give authorization for the above.

Signature:______________________________________   Date:__________________

Signature:______________________________________   Date:__________________

Signature:______________________________________   Date:__________________

Signature:______________________________________   Date:__________________

Please print, sign, and mail this application to us at:
American National Bank
Attn: Customer Service
P.O. Box 5009
Ardmore, OK 73403

American National Bank must receive your signed authorization before setting up your Electronic Banking accounts.

EFT Disclosures (please print and keep for your records)

American National Bank Electronic Banking Agreement