Overdraft Protection Form - First Mid Bank & Trust

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.

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.
Name*
First Last
Email*
Enter Email Confirm Email
Daytime Phone#*
Checking Account Number

Last Four Digits
Checking Account Number

Last Four Digits
Checking Account Number

Last Four Digits
Checking Account Number

Last Four Digits
Checking Account Number

Last Four Digits
Checking Account Number

Last Four Digits
Checking Account Number

Last Four Digits
Checking Account Number

Last Four Digits
Checking Account Number

Last Four Digits
Name
This field is for validation purposes and should be left unchanged.