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Submitted URL: http://enroll.arb.bank/
Effective URL: https://secure.americanriviera.bank/AmericanRivieraAutoEnroll/AutoEnrollmentnew.html
Submission: On December 25 via api from US — Scanned from US

Form analysis 1 forms found in the DOM

Name: OnlineEnrollmentPOST processform.aspx

<form name="OnlineEnrollment" id="OnlineEnrollment" method="post" action="processform.aspx" onsubmit="return validateData(document.OnlineEnrollment)"></form>

Text Content

Login Information

Please select a Login-ID that is between 8 and 30 characters in length. It may
contain all letters or all numbers. We recommend using something unique to
digital banking, and not your email address or any portion of it. You will use
this Login-ID once your account is activated. Desired Login Name*:

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 #/TIN*:
    Address*:   Address: City*: State*: Alabama Alaska Arizona Arkansas
California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois
Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan
Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey
New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon
Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah
Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code*: Home
Phone*: Work Phone:   Mobile Phone:   Email Address*:  

Account Number Account Type Account Number Account Type Please Select Checking
Savings Money Market Loan CD/IRA Please Select Checking Savings Money Market
Loan CD/IRA Please Select Checking Savings Money Market Loan CD/IRA Please
Select Checking Savings Money Market Loan CD/IRA Please Select Checking Savings
Money Market Loan CD/IRA Please Select Checking Savings Money Market Loan CD/IRA
Please Select Checking Savings Money Market Loan CD/IRA Please Select Checking
Savings Money Market Loan CD/IRA Please Select Checking Savings Money Market
Loan CD/IRA Please Select Checking Savings Money Market Loan CD/IRA Please
provide the 9 digit Account Number(s) that you wish to access through Internet
Banking. All accounts must have the same ownership as the information provided
in the Customer Information above.

Signature and Disclaimers

This document is being secured with SSL encryption provided by your browser.
Your information will be encrypted when using this form while in transit between
your browser and American Riviera Bank.

*Signature: *Date:   (Type your full name)   (Today's Date)



Important Disclosure Regarding Deposit Insurance on Noninterest-bearing
Transaction Accounts