Canandaigua National Bank & Trust Auto Enrollment Form
*Required Fields:
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*:
Social Security #*:
Address*:
Address:
City*: State*: Zip Code*:
Primary Phone*: Alternate Phone:
Mobile Phone:
Email Address*:
Verify Email Address*:
Account Number* Account Type
Please provide the Account Number(s) that you wish to access through Online Banking. All accounts must have the same ownership as the information provided in the Customer Information above.
Signature & Disclaimers:
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*Signature: *Date:
  (Type your full name)   (Today’s Date)