Online Banking through Quicken® Enrollment Form

Please print a hard copy of this form, fill it out, sign it and mail to:
(To print: Right click on your mouse and select print)
Commerce Bank, Online Banking, PO BOX 411635, Creve Coeur, MO 63141 (mail stop: WOOP-CC)

Enroll me in Online Banking through Quicken (Select one)
___ Online Account Access        ___ Online Account Access & Online Bill Pay        
___ Add Online Bill Pay to current Online Account Access

Software & Computer Information
Software Type: (Select only one) ___ Quicken®
Computer Type: ___ Windows ___ Macintosh

Personal Information

Name: _________________________________________________________________

Co-Applicant (for Joint Accounts): ____________________________________________

Address: _________________________________________________________________

City: _________________________________ State: ________ Zip __________________

Home Phone: (______)_________________ Work Phone: (_______)___________________
Do you have a Commerce account? ___ Yes ___No If No, do you want us to call? ___ Yes ___No
Best time to call: ___ AM ___ PM Where: ___ Home ___ Work

Security Information
Applicant Co-Applicant (Required for joint accounts)
Date of Birth: _______/_______/_______ Date of Birth: _______/_______/_______
Social Security #: _______-______-_________ Social Security #: _______-______-_________
Mother's Maiden Name: ____________________ Mother's Maiden Name: ____________________

Commerce Account Information Checking Account Number (Payment Account): __________________________
Other Account Number: __________________________

Authorization and Agreement (If joint account is desired, both applicants must sign.)
The undersigned applies for, and if approved, authorizes Commerce Bank to establish the requested Online Banking service (Service). The undersigned understands that the use of the Service is subject to the Online Banking Terms and Conditions provided with the fulfillment materials upon implementation. The undersigned understands that subscribing to the Service, or permitting another to use the Service, constitutes acceptance of the Online Banking Terms and Conditions. Commerce Bank is authorized to debit the designated Payment Account, or if no Payment Account is identified, the checking account opened by separate application, for monthly service charges until the Service is canceled.

Applicant Signature ________________________________ Date ___________

Co-Applicant Signature _____________________________ Date ___________

e-mail address (optional) __________________________

Would you like to receive special offers and information on our bank products and services via e-mail? ___ Yes ___ No

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