MidSouth Bank Online Banking Application

NOTE: Must be a MidSouth Bank customer to apply.Please complete the application online. Print, sign and return to the address below.

Account Owner/Signer Information
Please provide information for each account owner or signer on the accounts that will be accessed through Online Banking. Ownership on all accounts must be the same and match the individual(s) listed below.

Name – Primary Account Owner/Signer        

Name – Joint Account Owner/Signer  

Mother’s Maiden Name

Mother’s Maiden Name

User Id   (6 characters long)

User Id   (6 characters long)

Account Information
Please provide the Account Number for each account that will be accessed using Online Banking. Please note all accounts(s) must have the same ownership as the individuals(s) indicated above.

1.  All Accounts                        OR                

List individual accounts:

___________________________________

___________________________

Please indicate which checking or savings account should be charged for all Online Banking Service Fees.

Please indicate which checking account should be charged for the Online Bill Payment transactions.

Account #:

Account #:

ONLINE BANKING TERMS AND CONDITIONS AGREEMENT

I (We, if joint account holder) have reviewed the “Online Banking Terms and Conditions Agreement” for MidSouth Bank Online Banking Service and Optional Bill Payment Service and accept such Online Banking Terms and Conditions Agreement. By using the online financial services provided by MidSouth Bank, I/We agree to abide by the terms and conditions of this agreement.I/We hereby authorize MidSouth Bank to charge the primary account indicated above each month for the appropriate fee amount as outlined in the Online Banking Terms and Conditions Agreement.

______________________________________

______________________________________

Signature-Primary Account Owner/Signer - Date

Signature - Joint Account Owner/Signer - Date  

Return Application to any MidSouth Bank Branch Location or Mail To:
MidSouth Bank
Online Banking Department
P.O. Box 7100
Murfreesboro, TN 37133-7100