Overdraft Protection Form

Please tell us how we can help you so we can serve you better! Please select an option below and provide the requested information so that we can update our records accordingly.

* Required field

Authorization*

YES, I WANT First Mid Bank & Trust to authorize and pay overdrafts on my ATM and everyday debit card transactions.

NO, I DO NOT want First Mid Bank & Trust to authorize and pay overdrafts on my ATM and everyday debit card transactions.

First Name*

Last Name*

Email*

Confirm Email*

Daytime Phone#*

Checking Account Number* Last four digits

Checking Account Number Last four digits

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