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Parkway Office 16660 Dallas Parkway Suite 1700 Dallas, TX 75248 972-735-1000 View Map Preston Center Office
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Grand Bill Pay Application
To apply for Grand Bill Pay, complete
this
information, print, sign and return by fax or mail to:
GRAND BANK
Attn: Grand Bill Pay
P.O.Box 700337
Dallas, TX 75370
Fax: 972-735-1009
Yes! I want Grand Bill Pay!
Grand Bill Pay Customer Information
Customer Name
Social Security # Date of Birth
Home Phone Business Phone
E-mail Address
Sign me up for Grand Bill Pay
On-Line Banking Account Information (Ownership of accounts)
| Account Number |
Account Type |
| Checking | |
| Checking | |
| Checking | |
| Checking | |
| If you have additional accounts, click here for an expanded form which you may complete, print, and return to Grand Bank as part of this application. | |
| By signing my name or initials in the space provided following this paragraph, I hereby give permission to receive future disclosures and notification of changes to the terms and conditions via my email address noted above. I acknowledge that such disclosures and notifications may also be sent to the mailing address shown on the record of Grand Bank. ____________________________________________ |
Set-Up Request Cannot Be Processed Without Customer's Authorization
Signature
By signing below, I agree to comply with Grand Banking Anytime Terms and
Conditions and Disclosure, which I agree govern my account. I agree to all
terms and conditions provided herein, which may be changed from time to time
by the Bank in the manner provided herein, if applicable. My use of Grand
Bill Pay, if applicable, signifies that I have read and accepted all the
terms and conditions of the service including those referenced above. I have
received a copy of the Grand Bank Account Deposit Agreement Terms and
Conditions.
Please return my initial set-up password and user information to:
my email address at
or
my mailing address at
Customer Signature_____________________________________
Date____________
Customer Signature_____________________________________
Date____________
