Personal Internet Banking Enrollment Form
Customer Information
  * denotes required field
First Name*: Middle Initial: Last Name*:
Drivers License #*: Social Security #*:
Date of Birth*:  
City*:   Zip Code*:
Home Phone*: Work Phone:  
Mobile Phone:  
Email Address*:  
Date of Last Deposit*: Mother's Maiden Name*:  
User Name

Please enter your desired User Name. Your User Name can contain up to 12 characters consisting of letters and numbers. Each customer’s User Name must be unique. If the User Name you have requested is not available, PlainsCapital Bank will provide a similar but alternate User Name for you.

User Name*
Account Access Information
Please provide the Account Number, Account Type and Access Level for each account that you wish to access using Online Banking. All accounts must have the same ownership as the information provided in Customer Information above.
Account Number* Account Type Access Level Access Level Description

Full Access: View account(s) and make all online transactions including transfers.

View Only: View account(s), NO online transactions.

Signature & Disclosures
  Please click here to review a courtesy copy of the Consumer Deposit Account Agreement and Services Disclosure.
  Signature*: Date*:
  By entering my name above and clicking on the Submit Enrollment button, I hereby certify that the information I have provided herein is true and correct in all respects, and I acknowledge that my use of the PlainsCapital Bank Internet Banking System is governed and controlled by the Consumer Deposit Account Agreement and Services Disclosure and the Internet Banking System Disclosure and Agreement contained therein.