Cortland Banks

NETTELLER INTERNET ACCESS APPLICATION

To apply for Internet Banking, please print, complete, sign and mail this application to:

Cortland Banks
Attn: Internet Banking
PO Box 98
Cortland OH 44410

The account owner authorizes Cortland Banks to provide Internet access to their accounts and to transfer between accounts at customer's request. The customer listed below must have ownership to the accounts with a matching Tax Identification number.  All accounts of the owner may be accessible.

PERSONAL INFORMATION

First Name(s)

M.I.

Last Name(s)

Social Security #

1

2

MAILING ADDRESS

Street or PO Box

City

State

Zip Code

HOME PHONE #

WORK PHONE #

E-MAIL ADDRESS

 BILL PAY - I choose to pay my bills using my home or office computer.  I understand the recommended lead-time for an electronic payment is three business days and for check payments is five business days. Checking Account to debit for fees & payments: ________________

Please list all account numbers that you would like to access through the Internet:

1)

5)

9)

2)

6)

10)

3)

7)

11)

4)

8)

12)

Additional accounts may be listed on the back of this application.

I ACKNOWLEDGE MY RESPONSIBILITY TO HAVE SUFFICIENT FUNDS AVAILABLE IN MY ACCOUNT ON THE TRANSFER DATE OR AN ADVANCE ON A LINE OF CREDIT IF APPLICABLE, COULD OCCUR.  IT IS ALSO AGREED THAT THE BANK SHALL BE HELD HARMLESS FOR THE CORRECTNESS OF AMOUNTS SO TRANSFERRED.  INTERNET TRANSFERS MUST BE COMPLETED BY AN AUTHORIZED SIGNER ON THE ACCOUNT.  THIS AUTHORIZATION WILL REMAIN IN EFFECT UNTIL REVOKED IN WRITING.

I (the below undersigned) understand that by signing this application, I have authorized Cortland Banks to provide me Internet Transfer Service. Use of Internet Transfer Service shall be deemed to be my authorization to charge, debit or credit my account(s) for the amount and type of transaction(s) indicated at the time of use. Cortland Banks is hereby authorized to rely and act upon electronic instructions received from me or my authorized user in accordance with Cortland Bank guidelines.

By applying for and/or using Internet Transfer Service, I certify that all information I may furnish now or hereafter is true and complete; authorize and consent to investigation and verification of my application and account information through credit and check reporting agencies. As per our privacy policy, Cortland Banks does not share personal financial information with non-affiliated third parties.

The undersigned, jointly and severally, agree to be responsible for all charges, advances and other fees and to abide by all of the terms governing the services and my accounts. I understand that this application will remain property of Cortland Banks.

The undersigned also acknowledges receipt, and agrees to the terms of the Cortland Banks' NetTeller Agreement & Disclosure.

If joint account, both signatures are required.

REQUIRED:  To ensure confidentiality, please provide us with your mother's maiden

name. This will be used to verify identity if you need to contact NETTELLER support.

____________________________                             __________________________

Mother's Maiden (primary)                                               Signature of Authorized Signer

____________________________                             __________________________

Mother's Maiden  (joint)                                                    Signature of Authorized Signer

OFFICE USE ONLY

System

Generated ID

Account Set-up

Employee Initials

Branch

Account Set-up Date