Business Online Banking Enrollment Form

By completing this enrollment form, you agree to be subject to the terms of Bank of the Ozarks' On-Line Banking and Bill Payer Agreement and Disclosure Statement.

To enroll your company for On-Line Banking and Bill Payer, complete the form below, print complete form, have an authorized signer sign in the space provided, and drop it by one of our banking offices.

In the event you are unable to print this page, we will mail a completed form to the company for signature. Once we have received the signed enrollment form, we will send a Login ID and temporary password (in separate mailings) to each designated agent. The first time the designated agents login, they will be asked to change their passwords. Note: You can designate certain individuals to have access to On-Line Banking and bill pay features, and may customize daily dollar limits on bill pay.

Referred By: (employee's name)

Business Name:
Contact Name:
Street Address:
Suite/Office Number:
City: State:     Zip:   
Phone Number:           Fax Number:   
Business Email Address:  
Tax ID Number:
Primary Checking Account Number:
Requested Services
On-Line Banking
  Access account balances, transfer money, review history and conduct common banking tasks on-line. Monthly fee for On-Line Banking: Basic Business - Single user is $5; Basic Business - Multi user is $12; Cash Management Enhancement with additional modules starts at $45.
Bill Payment
  Pay bills on-line. Pay any company or individual. $5.95 for the first 15 bills paid each month and just $0.50 for each additional bill paid. The fee will be charged to the primary account.
Enroll for cash management service modules by contacting the cash management department at:
(501) 978-2229 or (501) 978-2253.
Account Information
  A. If you want to have full access to all accounts with the Tax ID Number above, please check the box below. This will include future new accounts.
Yes, I want to have full access to all my current and future accounts.
  B. If you want to access only select loan and deposit accounts, please list those accounts below.
Account Number  Account Type
Employee Supervisor Authorization
The individuals listed below have been authorized by the company to conduct business via Bank of the Ozarks' On-Line Banking. The On-Line Banking Security Supervisor that you designate will establish the individual user's rights (i.e., level of access for internal controls and maximum daily dollar limits.)
Designated Agent Name Is Agent a Security Supervisor?
Acceptance of Terms and Conditions
I have read and accept the terms and conditions set forth in the Bank of the Ozarks' On-Line Banking and Bill Payer Agreement (the "Agreement"). I agree that the Agreement, as amended from time to time according to its terms, will govern all transactions involving On-Line Banking and Bill Payer (the "Services"). The Agreement includes, without limitation, terms and conditions relating to preauthorized transfers initiated through the Services that are hereby authorized. I authorize Bank of the Ozarks (the "Bank") to deduct all fees and other expenses relating to the Services from the Primary Checking Account or, to the extent the Primary Checking Account lacks sufficient funds, from any of the company's other accounts maintained at the Bank. I authorize the company's payees to disclose to the Bank and its agents information regarding the account(s) with such payees in order to complete transactions initiated through the Services and to resolve questions regarding such transactions. Certification: I certify that the information provided is true and correct. I consent for Bank of the Ozarks (the "Bank") to verify any information included in this application with the credit bureau or other persons or companies and to obtain other information from them about the company. The use of the Services shall be governed by the Bank of the Ozarks' On-Line Banking and Bill Payer Agreement for Business and such other terms and conditions or amendments thereto, as may be established by the Bank and communicated in writing to me.
Name of Authorized Signer: Date:
Signature of Authorized Signer:    

Debit Card