Enrollment - Personal Information


Welcome to the SampleBank enrollment page. You're only four steps away from paying your bills online! Just complete this page so we can set up your account. If you have any questions about how SampleBank works, read through our frequently asked questions.

To sign up, all you need is:

  • Your checkbook (for your payment account number).
  • Your driver's license.
  • Your Social Security Number.

The information you provide is safeguarded using secure Internet data encryption technologies and is only used for setting up your bill payment account accurately.


This is Step 1 of the enrollment process. The information you provide here helps us maintain your account and enables us to efficiently process your payments. This information is only used for making payments in SampleBank.

Please complete the information on this page and click Continue.

Personal Information
First Name:

Middle Name:
(Optional)
Last Name:

Suffix:
(Optional)
Work Phone:

(xxx-xxx-xxxx) (Optional)
Home Phone:
(xxx-xxx-xxxx)
Have you had your home phone number for more than 4 months?
Yes
No
Is your home phone number published? Yes
No
Correspondence E-mail Address:
Current Address
Address 1:

Address 2:
 (Optional)
City:

State:
ZIP Code:

How long have you lived at your current address?
Two years or more
Less than two years (Complete the following address information.)
 
Previous Address 1:
 
Previous Address 2:
  (Optional)
 
Previous City:
 
Previous State:
 
Previous ZIP Code:
   

 

Is this information kept private?

How secure is the information I give to you?

 

What if I don't have a home phone?

What if I don't have a work phone?

 

 



Do you give my e-mail address to any other company?





 

 



 

 

 

Why do you need my previous address?