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Online Banking Application

Fill out this Online Banking Application completely and Submit. 

Note: Only one name per Application may be used. Information with an asterisk (*) is required to process your request. Applications without complete information cannot be processed.

Your NetTeller ID and PIN will be emailed to you via Secure Email within 3 - 5 business days after receipt of your completed Application. You must open the Email and follow the instructions – it will be the only communication you’ll receive for getting started with online banking. Should you have any difficulties, please contact Client Service @ 608.364.8924 or 888.769.2600. Reminder! If you have Easy Money Checking, you must enroll for eStatements to receive your monthly interest earnings and ATM refunds!

Account Holder Information

(example: 608-364-8911)

(example: 123-45-6789)
(If use is for a business account, please submit business' TIN)

(example: MMDDYYYY)

Account Information:

Please list below all accounts that you are a primary or secondary account holder of and would like to have Internet access to. Also list the description that you would like to use for each account that you have selected. (Examples of some descriptions you might use: Checking, Savings, Truck Loan, Home Loan, Vacation Account, etc.) No more than 20 characters can be used,including blanks. Do not repeat account descriptions or use special characters.

Account Number*
(account number will NOT be viewable online)
Account Identifier*
(account description to be used in place of account number)
Type of Account*
(Checking, Savings, Loan, etc.)

*Required Information

Please read before submitting:

By submitting, I request enrollment in NetTeller. I certify that the information is true and correct. I authorize Blackhawk Bank to verify any information included on this application, and allow Internet access only to the accounts that I may be a signer on, which are listed above. The use of NetTeller shall be governed by the printed terms and conditions or amendments thereto, as may be established by Blackhawk Bank and communicated in writing to me. I understand that the login ID and Password assigned to me by the Bank controls account security. My password must be changed the first time I log onto NetTeller. I will protect my Log In ID and hold the Bank harmless from any unauthorized use. Any information downloaded by me becomes my personal property and responsibility.