Prosperity NetBank - Internet Banking Services Application
This is a "print" application. Please print, complete, and forward to your local Banking Center.
I am applying for: (check one)
Prosperity NetBank only
Prosperity NetBank with Bill Pay
NetBank ID# and temporary PIN (to be assigned by Bank)
Personal Information (for NetBank set-up)
PRIMARY CUSTOMER:
Customer Name
Street Address
City
State
ZIP Code
List all accounts associated with Primary Owner. In addition, because account numbers are not displayed in NetBank, please choose an "alias" name for each account, for example, "Suzy's Savings" or "Household Checking." Please do not use numbers or special characters.

Account Number (1)
Alias (1)
Account Number (2)
Alias (2)
Account Number (3)
Alias (3)
Account Number (4)
Alias (4)
Mailing Address: (if different than Street Address)
Mailing Address
City
State
ZIP Code
E-mail address
Please read the Internet Banking Services Agreement & Electronic Funds Disclosure
I have read the above referenced disclosures and agree to the terms and conditions. By signing below, I hereby accept the terms and conditions of the Agreement. I authorize Prosperity Bank to set up all accounts opened by me on the Prosperity NetBank - Internet Banking Services. I further authorize you to charge my account for any transactions processed through the use of Internet Banking, including the amount of any recurring payment or transfer that I make. I agree to comply with all of the above referenced disclosures.

Applicant Signature
Date
For Bill Pay Set-Up, please complete the following section.

Primary Account Number to Debit for Payments & Fees
Home Phone Number
Social Security Number

Mother's Maiden Name (for account verification)
Work Phone Number