Union State Bank: Online Banking
Union State Bank
Union State Bank Online Banking Enrollment Form

*Required Fields
Login Information
Please select a Login-ID between 6-20 characters. It may contain all letters or a combination of letters and numbers; it is not case-sensitive and cannot contain spaces. Please select a Login-ID that you can remember as you will use this Login-ID once your account is activated.

Desired Login-ID*:
Customer Information
Please provide at least 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 #*:    
City*:   Zip Code*:
Home Phone*: Work Phone:  
Mobile Phone:  
Email Address*:  
Security Information
Please fill out this information section for security verification.

Date of Birth*:  
Mother's Maiden Name*:  
Date of Last Deposit*:  
Amount of Last Deposit*:  
Account Number* Account Type Access Level Access Level Description

Full Access: View account(s) and make all online transactions including transfers.

View Only: View account(s), NO online transactions.

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.
Signature and Disclaimers
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 Union State Bank.

*Signature: *Date:
  (Type your full name)   (Today's Date)