Online Business Banking Application Form
MILLENNIUM BANK

2077 MINER STREET - DES PLAINES, ILLINOIS 60016  

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