First Bank & Trust Company Online Banking Application Form

Important Information About Procedures For Opening An Account And Verifying Your Identity!
The First Bank and Trust Company is complying with the requirements of the USA Patriot Act!
To help the government fight the funding of terrorism and money laundering activities, Federal law requires ALL financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account at First Bank and Trust Company, we will ask for your name, physical address, date of birth and other information that will allow us to identify you. We will also ask to see your driver's license or other identifying documents. Thank you for your understanding and cooperation as we comply with the law and help to make our country safer and stronger!

This form is for existing customers of First Bank & Trust Company, serving Virginia and Upper East Tennessee. If you are not currently a customer, please visit the branch nearest you to open your account.

Important: All fields must be entered for us to process your enrollment form.

First Name
Middle Initial
Last Name
Company
Street Address
City
State
Zip
Email Address
Phone	( ) - ext
Social Security Number
	Note: If you are filling out this application for a corporation, please provide the Federal ID Number in place of the Social Security Number above.

Once we have received your enrollment form your Online Banking information will be mailed to you within 10 business days.

By completing this form and pressing the "Submit" button below I am hereby authorizing First Bank & Trust Company to establish my access to the Online Banking system. I understand that it is my responsibility to keep all login information confidential and secure and that First Bank & Trust Company will in no way be responsible for any loss, damages, actions, or other consequences that might result if I fail to safeguard any information, passwords, or other items relating to my accounts or access thereto.

Questions about enrollment?
Please email us. This information is solely for the use of First Bank & Trust Company and will not be shared with or sold to any other party.