Online Banking Application Complete all applicable fields on this form to request access to your accounts through Online Banking. Please read the Online Banking Service Agreement and Disclosure Statement now. Call 1-714-736-5700 with questions. Thank you. For security purposes, this application may not be submitted over the Internet. See the bottom of this form for instructions on how to present this application to the bank. By signing this application and using Uniti Bank's Online Banking service, I accept and agree to the terms and conditions set forth in the Online Banking Agreement and Disclosure Statement available by clicking here. This request is for Personal or Business use. Personal Accounts Last Name First Name Social Security # Street Address Mailing Address City State U.S. Only Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Zip Home Phone Work Phone Cell Phone Email   Business Accounts Company Name Tax ID # Street Address Mailing Address City State U.S. Only Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Zip Phone Toll Free Fax Website Email Access Accounts Please list all account numbers you would like to access via Online Banking. Accounts Checking #1 Checking #2 Money Market #1 Money Market #2 Savings #1 Savings #2 CD #1 CD #2 Loan #1 Loan #2   Additional Accounts Type of Account 1 Account Number 1 Type of Account 2 Account Number 2 Type of Account 3 Account Number 3 Type of Account 4 Account Number 4 Type of Account 5 Account Number 5 By submitting this application and using Uniti Bank's Online Banking service, I state that I have read and understand the terms and conditions set forth in the Online Banking Agreement and Disclosure Statement. For security purposes, please print out a copy of this completed application, sign the bottom and drop it off at any Uniti Bank location, fax to 714-736-5719, or mail it to Uniti Bank, 6301 Beach blvd. #100, Buena Park, CA 90621. I accept the Online Banking Agreement and Disclosures and request that I be enrolled in Uniti Bank's Online Banking. ____________________________________   ____________________________________ Signature   Date