Bank of Wausau

 

 

 

NetTeller Home Banking

Bank of Wausau Net Teller Application

Print, fill out, sign, and mail to: Bank of Wausau, P.O. Box 1406, Wausau, WI 54402-1406

LAST NAME:_____________________________ FIRST NAME:__________________

MIDDLE INITIAL:___

SSN:___________________ 

HOME PHONE:__________________ WORK PHONE:__________________

E-MAIL:_________________________________

CURRENT ADDRESS:______________________________________________

CITY:_____________________________________STATE:_________

ZIP:___________________

List below all accounts that you are a signer on and would like to be able to have access to. Also list the description you would like to use for each account you have selected. We will not pass any of your account numbers over the Internet. Examples of some account descriptions you might use are: checking, savings, consumer loan, home loan, commercial loan, etc. There is a limit of 20 characters (including blanks) in the description. Special characters are not allowed; Use only letters, numbers, and spaces. Do not use the same description for different accounts.

ACCOUNT DESCRIPTIONS (20 characters max)

|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

      ACCOUNT #:____________________________ 

|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

      ACCOUNT #:____________________________ 

|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

     ACCOUNT #:____________________________ 

|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

     ACCOUNT #:____________________________ 

|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

     ACCOUNT #:____________________________ 

|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

     ACCOUNT #:____________________________ 

|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

     ACCOUNT #:____________________________ 


FOR BANK USE:

INITIALS:_____________ DATE:_____________________ ID#:______________________________________________


PLEASE READ BEFORE SIGNING

AUTHORIZATION & AGREEMENT:  Upon application approval, all of my eligible accounts I hold with the Bank of Wausau, will be included in my NetTeller services.  I hereby authorize you, Bank of Wausau, to establish NetTeller to enable me to perform the transactions described in the service agreement.  I authorize you to process transactions for me as requested from time to time, and authorize you to post them to my accounts.  I authorize you to make any automatic recurring payments upon my direction.  I further authorize you to debit my checking account for the appropriate monthly fee for the services requested above.  I understand that my account will be debited monthly until I cancel the service.  I agree that my first use of NetTeller services will signify my acceptance of the other terms of the service agreement you will supply, along with instructions for using the services.

The Undersigned agrees to the same terms stated on the above,

Signature:________________________________________________ Date:____________________________________