Online Banking Enrollment Form
*Required Fields
Login Information
Desired Login ID*:
  • Your Login ID must be between 6 and 20 characters long.
  • Your Login ID may contain any of these special characters: `~!@#$%^&*()_+-={}|[]:”;’<>?,./\
Temporary Password*:
  • Your Password is required to be changed upon initial login
  • Your Password must be between 5 and 15 characters and contain at least one number, lower case letter and upper case letter
Customer Information
Please provide your contact information below, including your phone number to receive your secure access code to log in to your account.
First Name*: Middle Initial: Last Name*:
Social Security #*:    
Address*:  
Address:
City*:   Zip Code*:
Home Phone*: Work Phone:  
Mobile Phone:  
Email Address*:  
Name of Employer
Driver's License Number*: Driver's License State*:
Security Information
Please fill out this information section for security verification.
Date of Birth*:  
Mother's Maiden Name*:  
Signature and Disclaimers
This document is being secured with SSL encryption provided by your browser. Your information will be encrypted when using this form while in transit between your browser and Bank of Little Rock. Upon approval you will be notified via e-mail that your application has been accepted and you will be provided with the instructions necessary to complete the “First Time User” login process. During that process you will be presented with your Internet Banking Agreement and Disclosure Statement (Agreement) which you will need to “Accept”. You may print a copy to retain for your records.

This Agreement represents all of the terms and conditions agreed to in conjunction with the use of Internet Banking, and includes any other documents or disclosures executed pursuant to this agreement, state or federal law. I agree that I will not release my Login ID and password to anyone and that it is my responsibility to maintain the confidentiality of my Login ID and password to prevent unauthorized use. I certify that I am a Bank of Little Rock account holder and understand that I will only be provided online access to accounts of which I am an owner, or otherwise permitted by Bank of Little Rock.
 
*Signature: *Date:
  (Type your full name)   (Today's Date)