Enrollment - Business Contact and Security Information


This is Step 2 of the enrollment process. The information you provide here helps to verify your identity and ensure that your enrollment is as accurate and secure as it can be. This is also where you choose the user name and password you want to use with Your Financial Institution Small Business Bill Pay.

Please complete the information on this page and click Continue.

Note: The person enrolling now and providing the information below will be the level 1 user for this account. The level 1 user possesses the highest level of access to Sample Bank WebPay for Small Business.

Business Contact's Information
First Name:
 Is this information kept private?
Middle Name:
 (Optional)  

Last Name:
  
Suffix:
 (Optional)  

Address 1:
  

Address 2:
(Optional)  

City:
 

State:
 

ZIP Code:
-  

Business Contact's Phone:
(xxx-xxx-xxxx)  

E-mail Address:
(Optional) How is this e-mail address different from the business e-mail address?

Business Contact's Security Information
Business User ID:
What is the business user ID?
Password:
  

Re-enter Password:
  

Secret Word:
What is the secret word?
Social Security Number:
 (xxx-xx-xxxx)  

Date of Birth:
(mm/dd/yyyy)  
Driver's License Number:
  
Driver's License State: