Online & Telebank Enrollment

For your convenience, you may enroll for Online and / or Telebank services by using the following printable form.  Complete the following fields and click on the "Print" button at the bottom of the page to print the form.  Return using one of the following options:

FAX to: 712-542-4401
Return to our office by delivery or mail:  123 E. Main, Clarinda, Iowa, 51632
Office Hours:  Monday - Friday: 8:30 a.m. - 5:00 p.m.

Please enroll me in your Online Banking Service:

Please enroll me in your Telebanking Service:


*Last Name:

*First Name:

*Social Security Number:






*Zip Code:


Home Phone:

Work Phone:

Email Address:

Date of Birth:


**Preferred User Code:

*Primary Account Number:

*Type of Account:



Security Question:

(A question we can ask for verification)


Security Answer:  

(An answer we can expect to the above question)


* Indicates Required Field



** Indicates Required Field for Online Banking