FNBOnline Logon Request(Revised 05/03/07)
Name
Last 4 digits of SSN			City of Birth
Requesting Internet Banking Access to the Following Accounts:
Checking Accounts(D)			Savings Accounts(S)
Loan Accounts(L)			CD Accounts(T)
Christmas/VAC Club(X)			Safe Deposits(B)
			ODP(O)
Allow Transfers Between the Accounts Listed Above(Circle One): Yes / No
Request NetPay(Bill Payment) Function(Circle One):  Yes / No
Checking Account to have NetPay Capabilities:
$4.95 fee per statement cycle includes 10 items per cycle.  Additional items are .30 per item.  Both
fees are waived for Generations Gold Plus accounts.
Email Address
Customer Signature	______________________________________
To be completed by bank:
Please send request to MO-Document Imaging Rep/CSR
CIF Number:	___________
Bill Pay Code:	NP  or   WC		Sig Verified:	___________
Requesting FNB Emp.:	___________		Date Requested:	___/___/____
Entered By:	___________		Date Entered:	___/___/____
Verified By:	___________		Date Verified:	___/___/____