The Claxton Bank Personal Online Banking Enrollment

The form can only be processed with your signature.
Enter the information in the application, print, sign and return to any Claxton Bank location.

Main Office
121 West Main Street.
Claxton, GA 30417
912.739.3322 		  Bellville Office
Georgia Highway 292 .
Bellville, GA 30414
912.739.3322 		  Claxton Square Branch
U.S. Highway 301 North
Claxton, GA 30417
912.739.3322		   Newton Street Branch
3 South Newton Street.
Claxton, GA 30417
912.739.3322
On joint accounts, each signer must submit a separate application.
Customer Information
l
Please type and print
*Full Name
*Address
*Address
*City
 *State *Zip
*Daytime phone
Evening phone
Mobile phone
*email address
*Date of Birth
Drivers License Number
*Social Security Number
*Account Number
* indicates a required field
  
Requested Services
Account Access - Free
Access account balances, transfer money and
conduct common banking tasks online.		 Bill Payment - $4.95 per month
If you choose to use our bill pay service, you may set up your vendors and pay bills online.

For security and identification purposes please complete the following:

*City of Birth
*County of Birth
*Mother's Maiden Name

Signature:_________________________________________ Date:______________
By signing or submitting this form, I acknowledge that I have read and agree to the terms and conditions and I authorize The Claxton Bank to issue a temporary password on my behalf, which I must change to a private password of my choosing the first time I log in to TCB Online Banking.