Ephrata National Bank Online Banking Enrollment Form
This form is to be used by Personal account holders only. Business customers can enroll at any ENB branch location.
*Required Fields
Login Information
Please choose a User ID with the following requirements:

Between 4-15 characters, may contain any combination of letters or numbers except: no spaces, no dashes, and 9 numerals in a row. It is not case sensitive. Please select a user ID you can easily remember, as you will use it once your online account is activated.
Desired User ID*:
Customer Information
At least one phone number and one email address is required as an option to receive your secure access code for your Online Banking login. Entering a mobile number will allow the code to be delivered via SMS text message. You will be required to set your password after entering your secure access code. Note: Name fields cannot accept special characters.
First Name*: Middle Initial: Last Name*:
Social Security #*:  
Address 2:
City*: State*: Zip Code*:
Home Phone*: Work Phone:  
Mobile Phone:  
Email Address*:
Security Information:
Please fill out this information section for security verification.
Date of Birth*
Driver License Number
Mothers Maiden Name*
Amount of Last Deposit*
Account Number Account Type Access Level Access Level Description
Please provide the Account Number(s) that you wish to access through Online Banking. All accounts must have the same ownership as the information provided in the Customer Information section above.
* * *
Full Access - view account(s) and make all online transactions including transfers

View Only - view account(s), no online transactions
Signature & Disclaimer
Click here to view Terms and Conditions. This document is being secured with SSL encryption provided by your browser. Your information will be encrypted when using this form while in transit between your browser and Ephrata National Bank.

*Signature: *Date:
  (Type your full name)   (Today's Date)
For Internal Use Only
Branch: Initials: