Sign-Up for Personal Bill Pay

Fill out the form below, sign by typing your full name, and click "Submit". If you have other questions, please contact us.

NOTE: All information is required.

First Name:
Last Name:
E-mail Address:
E-Statements:


Security Phrase

(This word/phrase will appear in future e-statement notices from us so you know it is from Coulee Bank.)



There is no monthly fee for using bill pay and up to 20 bills per monthly statement cycle can be paid at no charge. (A 50¢ fee per item will be charged for any bills paid over the 20 monthly bill pay limit)

By typing your legal name below, you agree to the disclosures regarding our Internet Banking Customer Service Agreement and Disclosure Statement.

By using Home Branch, you acknowledge your receipt and understanding of this disclosure and agree to all terms and conditions of this Agreement.

Signature:
Todays Date:
Verification code:
If the words/letters in the verification box are difficult for you to read, click the refresh button in the verification window (the first blue button). If you do type in the verification code wrong and come back to this page, all of your information will be gone, you will then have to re-enter all of your information. This is done for your security.