Customer Name: _________________________________________________

Social Security Number: ___________________________________________

E-Mail Address: __________________________________________________

Mailing Address: _________________________________________________

Phone Number: __________________________________________________

Driver's License Number: __________________________________________

Mother's Maiden Name: ___________________________________________


All accounts on which you are listed as primary owner, secondary owner, co-signer, etc. may be accessible through First National Bank's "1st Choice NetTeller." If you prefer NOT to have all of your accounts accessible, please list those below. If more lines are needed, please attach a sheet of paper. We will not pass any of your account numbers over the internet, nor will any of our employees ask you for any account numbers over the internet.

Requested Services:

___ NetTeller           ___ NetTeller with Bill Pay  

DO NOT LINK THE FOLLOWING NAMED ACCOUNTS:

______________________________  ACCOUNT# _________________
______________________________  ACCOUNT# _________________
______________________________  ACCOUNT# _________________
______________________________  ACCOUNT# _________________
______________________________  ACCOUNT# _________________
______________________________  ACCOUNT# _________________

PLEASE READ BEFORE SIGNING

I certify that the foregoing information is true and correct. I authorize First National Bank of Oneida to verify any information included in this application and allow access to all accounts on which I may be a signer.** The use of "1st Choice NetTeller" shall be governed by the printed terms and conditions of the "1st CHOICE NETTELLER" AGREEMENT AND DISCLOSURE and such other terms and conditions or amendments thereto, as may be established by First National Bank of Oneida and communicated to me in writing. I acknowledge having received the "1st Choice NetTeller" Agreement and Disclosure Statement and also the signature agreement and disclosures signed at the time the account(s) were first opened.

The Undersigned agrees to the same terms stated on the above.

________________________________________
Signature
________________________________________
Date
** You may not designate any account that requires more than one signature for withdrawals. You must be the owner of the account.

Member FDIC