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  This Auto-Enrollment Form allows consumers and retail business account holders a convenient way to initiate Security First Bank Online access. Upon submission of this form, you will be contacted by us and your information will be verified. You will receive your login information from Security First Bank when your online banking service is ready for your use.

*Required Fields
  Login Information
 
Please enter your desired User Name. Each User Name must be unique. Your User Name can contain up to 15 characters consisting of letters, numbers and symbols. You may choose any of these 'special' characters`~!@#$%^&*()_+-={}|[]:?;?<>?,./\
Desired Login Name*:
   
  Customer Information
 
Please provide us with your information in the form below. The red Ď*í indicates required fields and the form canít be submitted unless filled in. Upon logging in for the first time you will select an option to receive a secure access code. This code will be required to be entered in and then you will be able to set your password.
First Name*:
Middle Initial:
Last Name*:
Business Name (if applicable):
Social Security or TIN#*:
Address*:
Address:
City*:
State*:
Zip Code*:
Primary Phone*:
Work Phone: Ext:
Cell Phone: *
Email Address*:
  Security Information:
 
Please fill out this information for security verification
Date of Birth*:  
Mother's Maiden Name*:  
  Signature:
 
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 Security First Bank.
*Signature: *Date:
  (Type your full name)   (Today's Date)