Glennville Bank - Internet Banking Application


	The form can only be processed with your signature. Enter the information in the application, print, sign and return to any Glennville Bank location..

Name:
Address:
City:
State:
Zip:
SSN:
Daytime Phone:
Email:
Mother's Maiden Name:

Please sign me up for The Glennville Bank Internet Banking. I understand
there is no charge for balance inquiries and transfers.

PC Operating System:
Windows 95/98/ME
Windows 2000
Windows NT
Macintosh
Don't Know

Internet Browser:
Internet Explorer 5.5+
Netscape Navigator 6+
AOL
Other
Don't Know

Online Accounts
Please check all the account types for which you want online access and detail
account numbers as well. We will activiate the accounts you select.

	All My Accounts			Checking
	Savings			Commercial Checking
	CD			Loan
	IRA			Loan
	Money Market			Other
	Other			Other

Signature ______________________________ Date ________________

Upon receipt of your signed application, instructions for accessing your account
online will be mailed to you.
.

Glennville Bank
102 East Barnard Street
Glennville, Georgia 30427
(912) 654-3471 * Fax (912) 654-1517

Ludowici Bank
5 Cypress Street
Highway 84 East
Ludowici, Georgia 31316
(912) 545-2530 * Fax (912) 545-3334

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