Mr, Ms, Mrs ...* |
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First Name* |
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Mid Initial |
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Last Name* |
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Title |
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Member/Institution Name* |
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Address* |
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Address |
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City* |
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State/Prov.* |
Zip/Postal Code
Country
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Telephone* |
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Fax |
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Why do we need your Email?
Providing your Email address enables us to send you Email acknowledgements.
If you are paying now with your credit card, providing your Email address also allows us to send you an Email receipt from the credit card company to confirm the transaction.
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Email* |
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PLEASE PROVIDE US THE REQUESTED INFORMATION BELOW. (*) means we need an answer from you.
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Your bank asset size (in millions)
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How many branches do you have?
(need a number)
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How many ATM machines do you have?
(need a number)
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*Do you do your data processing:
(Choose one item below)
In-house
By Service Bureau
not applicable
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Do you do your Item Processing by:
(Check one or more items below)
Front Counter
Back Counter
Merchant Capture
Item Processing Center
Other
not applicable
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*What teller system do you use?
(Choose one item below)
Web Teller
EZ Teller
Integrated Teller
Other
not applicable
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What Internet banking system do you use?
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What debit card processor do you use?
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Who is your bill payment vendor?
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Who is your mobile banking vendor?
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Who is your BSA software vendor?
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Please provide your bank’s contact E-MAIL ADDRESS for the following areas:
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IT
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LAS
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OPS
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RISK
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Submitting this form does not commit you to a credit card charge. You have not entered your number yet! After you have submitted this form, you will receive an (almost) immediate verification of the information you entered. Then, if you chose credit card payment, you will see your elected option. |
Click the button for your preferred payment method below. |