Personal Online Banking Enrollment Form
*Required Fields
Login Information
Your Login Name must be between 8 and 20 characters long. The user ID must be unique to our system.
Your Password must be between 8 and 15 characters and contain at least one number, one upper case letter, one number and one lower case letter.
Desired Login Name*: Temporary Password*:
 
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 #*: Date of Birth:*
Mother Maiden Name:*: Birth Place City:*
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 Account Type
 
Signature & Disclosures:
By clicking Submit Enrollment below, I certify that everything I have stated in this enrollment is correct. I authorize Horizon Bank to issue a temporary password on my behalf which I will be required to change to a private password the first time I log into the system.
       
        
 
 

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