Direct Connect Service Enrollment - First Mid Bank & Trust

Complete the following form to request Direct Connect services allowing a connection between your business online account and Quicken® or QuickBooks® Desktop. You must have a business checking account at First Mid Bank & Trust to sign up for Direct Connect services.

"*" indicates required fields

INSTRUCTIONS:

Please verify all information is correct and complete;
Please provide all requested information, including valid US address and phone number;
Submission of completed form constitutes a request for Direct Connect Services.

BUSINESS INFORMATION:

Tax ID*

Checking Account Number (1)*

Last Four Digits

Checking Account Number (2)

Last Four Digits

Checking Account Number (3)

Last Four Digits

Checking Account Number (4)

Last Four Digits

Name of Business*

Business Phone

Business Email

APPLICANT’S INFORMATION:

Applicant's Name*

First Last

SSN*

Last Four Digits

Date of Birth*

Applicant's Email*

Applicant's Phone

SERVICE TERMS:

The person(s) submitting this application is/are acting with full authority for the applying entity. This application for online services has been duly authorized by the Board of Directors, members, or general partners, as applicable, of the applying entity. Should this application for online services be accepted, the applying entity:

Agrees to defend, indemnify and hold the service harmless from any misuse of or unauthorized access to the online services performed on behalf of or in the name of the applying entity;
Agrees to a monthly fee of $10.00 until further notification to cancel the service is provided; and
Agrees that use of the service signifies acceptance of all the terms and conditions of the service.

Entry of your name and date below will serve as your electronic signature.

Name (Signature)*

Date*