Small Business Online Banking Enrollment Form
*Required Fields
Business Information
Please enter the following information for your business.
Business Name*:
TaxID/EIN*:
  • Your TaxID/EIN must be 9 numerical digits only, no dashes
Address*:  
Address:
City*: State*: Zip Code*:
Work Phone:  
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.
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 #*:
  • Your Social Security # must be 9 numerical digits only, no dashes
Home Phone*: Mobile Phone:  
Email Address*:  
Mother's Maiden Name*: Date of Birth*:  
Account Number* Account Type Access Level Access Level Description
Please provide the account number(s) that you wish to access through online banking. All accounts must have the same ownership as the information provided in the Client Information section above.

Full Access: View account(s) and make all online transactions including transfers.

View Only: View account(s), NO online transactions.

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 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)