logo Remote Deposit Capture Setup Form

We will need the following information in order to set up your business to remotely capture checks:

Business Information:

Business Name:

Address:

City: State: Zip:

Primary Contact (Superuser):
This is the primary contact person for your business. This person will be responsible for administrative tasks such as creating new users, setting up new sites, etc.

First Name:

Last Name:

Phone:

Email:

Username:
(This is the username you will use to login to the merchant capture program. Please do not use symbols or spaces. Must be at least 5 characters.)

Account(s) you would like to deposit into:
Please include the account number and a name you would like to use to identify the account (i.e. Payroll, Main Account, Account 1, etc.) the name keeps your account number confidential from those who will be scanning checks.

Warning! It is illegal to submit false or misleading information to a bank.

By pressing the submit button, I certify that I sign on the accounts to which I have requested access, and that I am lawfully entitled to the information or funds therein.

Note: You will receive a temporary password and further instructions during the onsite setup and training process. Call Kenneth Larsen at 435-865-2300 ext. 7377 if you have questions.