Please Select Your Bank of Western Oklahoma Branch:
Cordell Branch
Elk City Branch
Geary Branch
Vici Branch
Weatherford Branch
Woodward Branch
Personal Information
First Name, Middle Initial, Last Name
Date of Birth:
Physical and Mailing Address:
SSN/TIN:
City, State, Zip Code:
Email Address:
Home Phone, Work Phone:
Drivers License #, Issuing State, Expiration Date:
PowerPay Account Information (PowerPay Customers Only)
Checking account number to be used for paying bills with PowerPay:
Accounts to be accessed through NetTeller internet banking
Account Number:
Type of Account:
Account Ownership
By signing and submitting this enrollment form:
I acknowledge that I have received, read and agree to the the terms and conditions of the NetTeller© Internet Banking and PowerPay agreements and the Electronic Funds Transfers Disclosure, which may amend from time to time. I acknowledge that I have requested these services, and that the information provided is true and correct. I authorize Bank of Western Oklahoma to issue a Login ID and a temporary Password on my behalf, which I will be forced to change to a private Password the first time I log into the system. I understand that account security and access is controlled by my Login ID and Password and I agree to safeguard this information and control its use. I understand and agree that Bank of Western Oklahoma cannot control or be held liable for the security of my personal computer and I agree to take the appropriate measures to secure my personal computing environment. I understand and agree that any information downloaded by me becomes my personal property and responsibility. I agree to notify Bank of Western Oklahoma immediately if the confidentiality of my Login ID and/or Password is compromised. I agree to hold Bank of Western Oklahoma harmless from any unauthorized use, unless prohibited by law. I authorize Bank of Western Oklahoma to honor all transactions using my Login ID and Passwords.
Applicants Name:
Date: