Fairfax State Savings Bank's Online Banking Enrollment Form
*Required Fields
Login Information
Your Login Name must be between 8 and 12 characters long. The user ID must be unique to our system.
Your Password must be between 7 and 15 characters and contain at least one number, one upper case letter, and one lower case letter.
Desired Login Name*: Temporary Password*:
Customer Information
Please provide at least one email address and one phone number to receive your secure access code for your Online Banking login. You will be required to set your password after entering your secure access code.
First Name*: Middle Initial: Last Name*:
Business Name: (If Applicable)
Social Security #*: Date of Birth:*
City*: State*: Zip Code*:
Home Phone*: Work Phone:
Mobile Phone:
Email Address*: Bank Use Only:
Account Access Information
Please provide the Account Number(s) that you wish to access through Online Banking. All accounts must have the same ownership as the information provided in the Customer Information above.
Account Number* Account Type Access Level Access Level Description

Full Access : View account(s) and make all online transactions

View & Deposit : View account(s) and make online deposits, NO withdrawals.

View Only : View account(s), NO online transactions.

Deposit Only : Make online deposits, NO viewing or withdrawals.
Additional Access Requested*
Bill Pay Access          Mobile Access       
Signature & Disclosures:
By clicking Submit Enrollment below, I certify that everything I have stated in this enrollment is correct. I authorize Fairfax State Savings Bank to issue a temporary password on my behalf which I will be required to change to a private password the first time I log into the system.