Stillman Business Online Application Form

Please fill in all information below and click on ‘Format for Printing’ so that company officers/owners can print and sign the completed form.

Please include area code



Please indicate below which business checking and/or loan accounts you would like to access via Stillman Online:

Account #
Nickname


Company will be assigned a user identification number and a password. Company designated administrator will also be assigned an individual user ID and password. Company administrator is responsible for assigning all additional user identifications and passwords to Company personnel who you wish to access Company accounts via Stillman Business Online. Company is responsible for maintaining the confidentiality of all user ID's and passwords and for all activities and transactions that occur under any assigned password. In the event that the Company, or any Company user, permits any other person to use Stillman Business Online or their password, then Company will have authorized that person to access its accounts and to initiate transactions. Stillman BancCorp N.A. will not be liable for any loss or damage incurred by your business as a result of said breach of security or your failure to comply with these security requirements.

The undersigned agree(s) to the terms, conditions and disclosures stated on this application and in the "Stillman Online Banking Agreement and Disclosure Statement." These terms are subject to change.

Signature(s) of Corporate Officer(s) or Business Owner(s) whichever is appropriate.
(Person signing the top line will be considered the Administrator of your account.)

Signature:
Date:
Print Name:
Signature:
Date:
Print Name:
Signature:
Date:
Print Name:

Please mail or fax to: Attention: Stillman Online, Stillman BancCorp N.A., P. O. Box 150, Stillman Valley, IL 61084, Fax: 815-645-2341