Online Banking Application

Sign up for Online Banking by completing this form. Upon receipt of this application, a representative will respond by email to eligible applicants with login instructions. Please ensure that the information you provide is fully completed and accurate as it will be used to verify your identity. Feel free to contact us at 260‐563‐3185 or internetbanking@crossroadsbanking.com with any questions.

Account Information

Authorization

I (the Account Holder/s) apply for the online banking service to be used in conjunction with the accounts listed above. I understand that this online banking service will be set up (pursuant to my instructions) with the functions, features, and/or additional provisions indicated above and that my use of this service will be subject to the terms and conditions contained in this application as well as the Agreement and Disclosure presented upon login. I authorize Crossroads Bank to make any investigation of my credit either directly or through any agency. I understand that Crossroads Bank will retain this application and any credit information, even if I am not approved for this online banking service. I agree not to use this service in any illegal activity.