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To begin, please fill out the fields in the form below. A Bank representative will follow up with you in regards to your submission within one business day.

Business Online Banking Enrollment Request

    Please complete the information below to enroll in Business Online Banking. Once your request has been processed, you will receive instructions to access Online Banking. You may also complete this request to add new users, new accounts, Online Bill Pay, and eStatements to your existing Business Online Banking set up.

Select Type of Request

    OK is required
  • Change Existing Business to:

    OK Change Existing Business to: is required

Business Information

  • OK Business Name is required
  • OK Permanent Address (Not a P.O. Box) is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • OK Business Phone is required
  • OK Business E-mail is required
  • OK Business Tax ID Number (If DBA, Owner SSN) is required
  • OK Primary Business Account # is required

Authorized Representative Information

    *Must Match Bank records based on Primary Business Account
    Business Owner (Sole Proprietor/Partnership), Managing Member (LLC), or CEO/CFO/Secretary (Corporation)

  • OK Full Name is required
  • OK Driver's License / ID # is required
  • OK Last 4 Digits of Social (SSN) is required
  • OK Date of Birth (MM/DD/YYYY) is required

User Information

    User 1 - Information

  • OK Full Name is required
  • OK Login ID is required
  • OK User Email Address is required
  • OK User Phone is required

     

    Account Number 1
  • OK Account Number is required
  • OK Account Type is required
  • User Access Level: (Check all that apply)

    OK is required

     

    Account Number 2
  • Optional OK Account Number is required
  • Optional OK Account Type is required
  • User Access Level: (Check all that apply)

    Optional OK is required

     

    Account Number 3
  • Optional OK Account Number is required
  • Optional OK Account Type is required
  • User Access Level: (Check all that apply)

    Optional OK is required

    User 2 - Information

  • Optional OK Full Name is required
  • Optional OK Login ID is required
  • Optional OK User Email Address is required
  • Optional OK User Phone is required

     

    Account Number 1
  • Optional OK Account Number is required
  • Optional OK Account Type is required
  • User Access Level: (Check all that apply)

    Optional OK is required

     

    Account Number 2
  • Optional OK Account Number is required
  • Optional OK Account Type is required
  • User Access Level: (Check all that apply)

    Optional OK is required

     

    Account Number 3
  • Optional OK Account Number is required
  • Optional OK Account Type is required
  • User Access Level: (Check all that apply)

    Optional OK is required

    User 3 - Information

  • Optional OK Full Name is required
  • Optional OK Login ID is required
  • Optional OK User Email Address is required
  • Optional OK User Phone is required

     

    Account Number 1
  • Optional OK Account Number is required
  • Optional OK Account Type is required
  • User Access Level: (Check all that apply)

    Optional OK is required

     

    Account Number 2
  • Optional OK Account Number is required
  • Optional OK Account Type is required
  • User Access Level: (Check all that apply)

    Optional OK is required

     

    Account Number 3
  • Optional OK Account Number is required
  • Optional OK Account Type is required
  • User Access Level: (Check all that apply)

    Optional OK is required

    -More than 3 users: Please submit an additional enrollment request.-

    -More than 3 Accounts per user: Please submit an additional enrollment request.-

    Bill Pay: Users with Online Bill Pay selected for an account will have access to EVERY Account within Bill Pay.

eStatement PDF Verification

Acknowledgement and Acceptance

    Please Note:

    • You must be an Authorized Representative (as defined above) on each of the accounts listed above.
    • All customer information listed above will be verified / validated against the records of the Bank.
    • All Accounts, Users, and corresponding User Access will be granted as shown above.

    I acknowledge receipt of and accept the terms of the Online Banking Service Agreement and Disclosure. It is resolved that Bank is authorized to grant the persons listed above access as users of the Bank's Business online Banking on behalf of the company, per a resolution adopted by the Board of Directors, owners, or managing members of the Company. I certify that I am an authorized representative for the Company as listed above, and as such, I am authorized to enter into this agreement on behalf of the Company. I agree that confidentiality of a User ID and Password is the responsibility of the each user. I agree to promptly review the account activity and notify the Bank of any errors. The Bank is not liable for errors that may result from failure of any user listed to properly administer the accounts and/or properly control their password. I agree to receive important regulatory information via an electronic medium, which can be printed or downloaded for future reference.

    I understand that the Bank will verify the information provided in this request against the records of the Bank for the business, authorized representative, and accounts listed. I understand that this enrollment request will not be granted should any information provided on this request not match the records of the Bank. “Bank” as defined in this enrollment is in reference to one of the following, as applicable: City Savings Bank - Deridder, LA; Coastal Commerce Bank - Houma, LA; Kaplan State Bank - Kaplan, LA; Teche Bank and Trust - St. Martinville, LA; or Tri Parish Bank – Eunice, LA. These named banks are collectively the subsidiary banks which are owned by Louisiana Community Bancorp, Inc.

    Personal Account Authorization: I authorize the Bank to include my personal accounts, should any be listed above, for access under my Business Online Banking. I understand that any person or user listed above will have access to any and all personal account information as outlined above. I agree that except as stated in the Online Banking Service Agreement and Disclosure, or otherwise required by law, the Bank is not liable for any indirect, incidental, special or consequential damages including loss of profit, revenue, data, or use as a result of my personal account information being included under my Business Online Banking.

    By clicking "Submit", I certify all information contained herein is accurate, I agree to all terms and conditions outlined and referenced herein, and authorize the Bank to process my request as stated above.

  • OK Date (MM/DD/YYYY) is required

Security Code

  • OK is required
  • Kaplan State Bank reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, you grant full permission to do so.

    Please print, sign, and return the completed form to your local bank branch.

    Signature: ______________________________