Express Pay

Loan Information

• Name
  OK Name is required
• Home Phone
  OK Home Phone is required
• Daytime Phone
  Optional OK Daytime Phone is required
• E-mail
  OK E-mail is required
• Residential Address (Not a P.O. Box)
  OK Residential Address (Not a P.O. Box) is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required
• Bank Name
  OK Bank Name is required
• Bank Account in the name of:
  OK Bank Account in the name of: is required



• Account Type:

  • Checking
  • Savings
  OK Account Type: is required
• Bank Routing Number (9 digits at bottom left corner of check, do not include spaces or hyphens):
  OK Bank Routing Number (9 digits at bottom left corner of check, do not include spaces or hyphens): is required
• Bank Account Number (follows Bank Routing Number on check, do not include spaces or hyphens):
  OK Bank Account Number (follows Bank Routing Number on check, do not include spaces or hyphens): is required
• FNB Community Bank Loan Number to be credited:
  OK FNB Community Bank Loan Number to be credited: is required
• Name(s) on Loan at FNB Community Bank
  OK Name(s) on Loan at FNB Community Bank is required
• How much are you paying today: $
  OK How much are you paying today: $ is required

• Do you want this to be a recurring payment?

  • Yes
  • No
  OK Do you want this to be a recurring payment? is required

• Security Code
  OK Security Code is required

By clicking Submit below, I certify that everything I have stated in this application is correct. FNB Community Bank may keep this application whether or not it is approved. By submitting this application I authorize FNB Community Bank to check my credit and employment history and to answer questions others may ask FNB Community Bank about my credit record with FNB Community Bank. I understand that I must update credit information at FNB Community Bank's request if my financial condition changes. I understand that there is an ACH Convenience Fee of $7.50 associated with utilizing Express Pay.

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