Name:

 
 

Daytime Phone:
 
 
Address:
 
 

Email Address:

  
 
Account Number:

 
 

I have read and accept the terms of the Peoples Bank & Trust Hometown Banking @ Home Agreement and wish to enroll.

Signature:

 

Date:

 

Mail to:

Attn: Bill Pay
1899 Buford Hwy
Buford, GA 30518