application instructions
Please complete this application and bring it to the Jefferson Banking Center
nearest you or mail it to the address at the bottom of the following page.
account manager access
business online banking
jeffersonbank.com
Please complete the application and bring it to the Jefferson Banking Center
nearest you or mail it to the address at the bottom of this page.
NEW TO ONLINE BANKING
EXISTING ONLINE BANKING USER
business information
Business Name:
Business Owner:
Ownership:
Sole Proprietor
Limited Partnership
Corporation
Public Entity
General Partnership
Association
Limited Liability
Company
Address:
City/State/Zip:
Daytime Phone:
Email Address:
account(s) for access
Use the table below to list all accounts you want to access online. Each account can be associated with an easy to remember pseudo
name (reference), so please choose a descriptive name for each account. For security purposes you may not use your account
number as a pseudo name.
ACCOUNT NUMBER
ACCOUNT TYPE
REFERENCE NAME
designation of business agent
I authorize Jefferson Bank to establish Business Agents for access to my bank accounts using Jefferson Services. I understand that my
Business Agent is authorized to utilize the complete services offered by the Account Manager Access Services.
• Real-time account balances
• Transaction history
• Bank statements
• Stop payments
between
• Transfers
business accounts
• Images of cancelled checks
• Business loan information
bank statement
• Archive
to business computers
• Business loan payment
business resolution
I
, certify that I am a Sole Proprietor, Corporate Officer, Partner or Equivalent Company
Officer, and I hereby warrant that I possess the authority to:
1. Designate Business Agents for Online Banking Services
2. Designate Bank Accounts for use by the Business Agents
Business Owner/Equivalent Officer
Title
Date
Electronic Banking Department • PO Box 5190 • San Antonio, Texas 78201-0190
Phone (210) 734-4311 • Fax (210) 736-7652
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B6013-0315
account manager access
business online banking
jeffersonbank.com
business agents
BUSINESS AGENT #1
Name:
Position:
Social Security Number:
Date of Birth:
Drivers License Nr/State:
Inquiry Code*:
Business Email:
Residential Address:
City, State, Zip:
Business Accounts:
Business Accounts:
I agree to the appointment as a Business Agent as designated by Business Owner/Equivalent Officer.
Business Agent
Date
BUSINESS AGENT #2
Name:
Social Security Number:
Drivers License Nr/State:
Position:
Date of Birth:
Inquiry Code*:
Business Email:
Residential Address:
City, State, Zip:
Business Accounts:
Business Accounts:
I agree to the appointment as a Business Agent as designated by Business Owner/Equivalent Officer.
Business Agent
Date
*An Inquiry Code is a word (maximum of 15 characters) that will identify you if you need to contact Jefferson Bank by phone.
Electronic Banking Department • PO Box 5190 • San Antonio, Texas 78201-0190
Phone (210) 734-4311 • Fax (210) 736-7652
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B6013-0315
account manager access
business online banking
jeffersonbank.com
The Business Owner/Equivalent Officer agrees to the following provisions for use of the Account Manager Access for Jefferson
Business Online Banking (“Jefferson Services”).
appointment of business agent
The Business Owner/Equivalent Officer appoints the Agent authorized on the Account Manager Access Application as its
agent and agrees that the Agent may act on/in its behalf in utilizing the Jefferson Services.
procedures
Agent shall follow the procedures outlined in the Business Online Banking Agreement. Business Owner/Equivalent Officer
represents that it is in compliance with the security procedures in the Business Online Banking Agreement and it has in place
appropriate and effective security procedures to protect and ratify each action taken by Agent. Agent acknowledges that he is
aware of such security procedures and agrees to comply with each such procedure.
indemnity
Business Owner/Equivalent Officer shall indemnify Jefferson Bank against any loss, liability or expense (including attorneys’
fees and expenses) resulting from or arising out of any breach of any representation or agreement or any action taken on its
behalf by Agent.
relationship of parties
Under this Addendum and for purposes of Jefferson Services, Agent is an agent of Company. Company
acknowledges and agrees that Agent is acting on its behalf. Agent is not acting as an agent of Jefferson Bank
termination of agent
The Business Owner/Equivalent Officer agrees to notify the Bank in writing if the Business Agent has been terminated or the
Account Manager Access should be revoked.
business authorization-business owner/equivalent officer
By signing this application, I warrant that I am the owner of the deposit accounts designed for Account Manager Access
Services maintained by the business entity and I agree to the terms and conditions of the Account Manager Agreement and the
Business Online Banking Agreement.
Business Owner/Equivalent Officer
Title
Date
MAILING INSTRUCTIONS
Jefferson Bank
Electronic Banking Services
PO Box 5190
San Antonio, Texas 78201-0190
Electronic Banking Department • PO Box 5190 • San Antonio, Texas 78201-0190
Phone (210) 734-4311 • Fax (210) 736-7652
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B6013-0315