| Online Business Banking Application Form | |
| MILLENNIUM BANK | |
| 2077 MINER STREET - DES PLAINES, ILLINOIS 60016 | |
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To enroll for Millennium Bank Business Online Banking please print this form, choose from the list of services below, complete your information and fax to 847-296-9501. During banking hours we will process this enrollment form and send you an e-mail letting you know when you are able to log into our system. Included in this e-mail will be your user name and temporary password. If you have any questions, please contact a Personal Banker at 847-296-9500. On-Line Banking only ______ On-Line Banking with Bill Pay ______ Business Name: ______________________________________________________________________ Signer(s) Name: ______________________________________________________________________ Signer(s) Name: ______________________________________________________________________ Signer(s) Name: ______________________________________________________________________ Address: ____________________________________________________________________________ City: _______________________________________________ State: __________ Zip: ________ Contact Phone Number(s): ______________________________________________________________ FEIN Number: __ __ - __ __ __ __ __ __ __ E-Mail Address: _______________________________________________________________________ Checking Account Number: ________________________ Certificate of Deposit: _________________ Savings Account Number: ____________________ Loan Account: ___________________________
____________________________________________________________________________________ Signature of Authorized Signer(s) Date
____________________________________________________________________________________ Signature of Authorized Signer(s) Date
____________________________________________________________________________________ Signature of Authorized Signer(s) Date
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