Business Banking Enrollment Form

To sign up for Business Banking, complete and submit the following application in its entirety. If you prefer, the signed application may be sent to Farmers & Merchants Bank at 25 Westminster Pike, P.O. Box 249, Reisterstown, MD 21136, faxed (410-517-3064), or hand delivered to any branch location. Once the application is returned to us and processed, you'll receive a personal login ID and first time password via email.
Customer Information:
First Name... or Full Company Name:
Last Name...or Name of Company Contact:
Address:
City:
State
Zip:
Phone:
E-Mail:
Social Security Number or Tax ID #:
Primary Checking Acct. #:
P.I.N. -

During this enrollment process, each enrollee must complete the P.I.N. field with a designated Personal Identification Name and/or Number that can be used for security purposes. This will be used for customer identification in the event that your user password has to be manually reset by Farmers & Merchants Bank. (i.e. Mother's Maiden Name, Birth date, Telephone Number, etc.)

Requested Services:

	Business Banking & Free Bill Payment
Access account balances, transfer money, and utilize the Free Bill Payment feature. There is no charge for this service.

Account Information:

You must be an authorized signer on each of the accounts selected for online access. Passbook savings accounts must first be converted to statement savings accounts before they can become accessible via Online Banking. Please visit your local branch to convert.

Account Number and Access Type*:

			Account Description, as you identifiy this account:
1)
2)
3)
4)
5)
6)
7)
8)

* Definitions for Access Types:

Full Access - You will have the full access available on this account, and full access is required for the Free Bill Payment service.
View & Deposit - You may view account information and transfer funds into this account.
View Only - You will be able to view balances and transactions.
Deposit Only - You will be able to transfer funds into this account from other accounts with Full Access. You will not be able to view balance or transaction information.

Please Note: You must be an authorized signer on each of these accounts.

Bill Payment: if desired for your organization, please provide the following information to assist in setup and future validation of identity with CheckFree Small Business Bill Pay for research requests.

Driver's License Soundex Number:	The number should be listed as one (1) letter followed by twelve (12) numbers: [i.e. A-000-000-000-000]
Driver's License State:

Requested Services:

Business Mobile Banking & Remote Deposit Check Capture

e-Statements:

In accordance with my secure multi-factor authentication (MFA) and login credentials for this internet banking service, I would desire to enroll for electronic access/delivery of monthly transactional e-Statements in Adobe pdf.file format from Farmers and Merchants Bank and discontinue the mailed statement of activity by the bank at this time.

Yes, OPT-IN for e-Statement Service

To discontinue this e-Statement access/delivery, please provide notification to Farmers and Merchants Bank at 410-517-3065 or by e-mail notification to [email protected]