Platte Valley Bank  
NetBANKING/Bill Pay Business Application

NEW CUSTOMER sign up for NetBANKING!

New CUSTOMER sign up for Business NetBANKING. Complete the ENTIRE Business Application. If you also want Business Bill Pay,
check the Business Bill Pay "Yes" Box (below) and identify the checking account number to be used for Bill Pay.

If you are a current Business NetBANKING customer and want Bill Pay, complete only the application items in "BLUE",
in addition to your *Netteller ID# . Check the Business Bill Pay "Yes" Box (below), and identify the checking
account # to be used for Bill Pay.

Note: Your SSN is entered on the business application for our records "only" as authorized agent to open a NetBANKING account. After enrollment
has been approved you will use your Tax ID number, together with your secret 4-digit alphanumeric PIN (entered in a later step), to sign on to NetBANKING.

Business Name:

Tax ID Number :

Authorized Agent :

Agent SS Number :

Mother's Maiden Name:

Driver's License Number:

Driver's License State:

Business Address :

City:

State:

Zip Code :

*Netteller ID Number:
for current users only

Business Phone:

( ) -

E-mail Address:

Re-type E-mail Address:

Below, list the business account numbers and title of accounts, to which you are an owner, and would like to have NetBANKING access.

*Use up to 20 characters (do not use punctuation, but spaces can be used) to identify you accounts. These names can be changed on
NetBANKING once you are signed-on.

Account Number(s) for NetBANKING

Title of Account*

For confidentiality reasons when using NetBANKING, your business account numbers will not be provided over the Internet.

"CASH MANAGEMENT"

. This would allow you, your secretary or bookkeeper
to manage your company bank account from the office.

. You would be able to create and initiate wire transfers
or new ACH batches with the ease of a few buttons.

. You could transfer funds between accounts, view your
accounts such as payroll, general account, etc. and
prior day information.

. Cash Management allows you to add other users to
your system, as well as the ability to edit each user's
accessibility to accounts and features.

If you want BUSINESS Bill Pay, check the "YES" box.

Business Plan Option 05
$8.95 monthly charge with 20 free payments
and forty cent charge per item over 20.

Yes

Identify the checking account # you want tied to Bill Pay below.

I am a Current Customer:

I am not a customer and will need to open at least one eligible business account with Platte Valley Bank for NetBANKING, which could include either a checking account, savings account, money market account, certificate of deposit, loan and/or line of credit.

To have Bill Pay I will need to have one
active checking account.

NE: Scottsbluff (308) 632-7004 WY: Torrington (307) 532-2111 WY: Wheatland (307) 322-9215
Copyright © 2007 Platte Valley Bank. All rights reserved. Members FDIC. Equal Housing Lenders.