Internet Banking Registration Form

GREENSBURG STATE BANK

Internet Banking Registration Form

Print this form and present personally to bank officer or customer service representative at
Greensburg State Bank, Greensburg, KS

Security Tips

Internet Service Convenience

Identity Procedure

GSB Home Page

SSN / Tax ID _____________________________
Name (First/Middle/Last):________________________________________

User Code Requirements:
Your User Code (log in name) must be between 8 and 17 characters in length, can be either lower case or upper case.

Choose your USER CODE

Password Requirements:
Your Password must be between 8 and 17 characters in length and contain:

2 (two) numbers

2 (two) letters (either upper case or lower case)
NOTE: This is a temporary password. You will be asked to change this the first time that you log on.

Choose your PASSWORD

Confirm your PASSWORD

Your Contact Information:

Physical Address

Mailing Address

City

State

Zip

Home Phone

Cell Phone

Work Phone

E-mail Address

List all accounts you would like to activate for Greensburg State Bank Internet Banking
Account Type Account Number

The first time you sign on to the Greensburg State Bank Internet Banking System, you will need to enter your USER CODE that you set up on this sheet. You will keep this user code. Your password will change. You will access the system the first time with the password that you set up on this sheet but when you log in the first time it will ask you to change that password. Important Information About Procedures for Opening a New Account

Greensburg State Bank
240 South Main, P.O. Box 787
Greensburg, KS 67054 World Wide Web page: bestbank.us Phone: (620) 723-2131 (620) 723-2611 email: gsb@bestbank.us

04/20/2008


Physical Address
Mailing Address
City
State
Zip
Home Phone
Cell Phone
Work Phone
E-mail Address