Personal Online Banking Enrollment

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 sign up for On-Line Banking and Bill Payer, complete the form below and click on the submit button. Also, print the completed form, sign in the space provided for your signature, and drop it by one of our branches or mail to: Bank of the Ozarks, E-Banking Dept., PO Box 196, Ozark, AR 72949. In the event you are unable to print this form, we will mail a completed form for your signature. If you stop by a branch with a completed enrollment form we will provide you with your Login ID and temporary password at that time. However, if you prefer to sign up online we will mail you a Login ID. Once we have received your signed enrollment form, we will mail you a temporary password. You will need both the Login ID and password to access your accounts. The first time you login, you will be asked to change your password.
Referred By: (employee's name)

First Name:    Middle Initial:
Last Name:
State:   Zip:    Phone:
Email: Mother's Maiden Name:
Social Security Number:
Joint Applicant's Social Security #:
Primary Checking Acct. #:
Requested Services
On-Line Banking
  Access account balances, transfer money, review history and conduct common banking tasks online. There is no charge for this service.
Account Information
  A. If you want to have full access to all accounts on which you are the Primary Owner (account tied to your Social Security Number) 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 only want access to select loan and deposit accounts, please list those specific accounts below. You may include accounts that you are authorized to access but which are not tied to your social security number. Please note you must be a signer on each of these accounts.
Account Number Access Type Personal account description
(Example: John's checking)
 Account Type
* Definitions for Access Types:
  • Full Access - You will have the full access available on this account.
  • View & Deposit - You may view account information and transfer funds into this account.
  • View Only - You will be able to view balances and transactions.
  • Deposit Only - You will be able to transfer funds into this account from other accounts with Full Access. You will not be able to view balance or transaction information.
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 and Disclosure Statement (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 my Primary Checking Account or, to the extent my Primary Checking Account lacks sufficient funds, from any of my other accounts maintained at the Bank. I authorize my payees to disclose to the Bank and its agents information regarding my 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 me. I consent for the Bank to allow access through the Services to all the accounts on which I am an authorized signer. The use of the Services shall be governed by the Bank of the Ozarks' On-Line Banking and Bill Payer Agreement and Disclosure Statement and such other terms and conditions or amendments thereto, as may be established by the Bank and communicated in writing to me.
Applicant Signature: Date:
Joint Applicant Signature: Date:
Thank you for enrolling On-Line. Please print this form, sign it and drop it off at your local branch or mail it to: Bank of the Ozarks, E-Banking, PO Box 196, Ozark, AR 72949. Joint applicant must be an authorized signer on all accounts referenced above.

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