Harleysville Bank Online Banking Enrollment Form
For Personal and Business Accounts
Thank you for choosing Harleysville Bank for all your banking needs. Online basic services include access to account balances, funds transfers, transaction history and more. If you already have an online banking login/user name, there is no need to re-enroll. Call us at 1-800-243-8700 if you need assistance or have questions about your log in information. If you are already an online banking user, please click here to use your existing “USER-ID” to sign on; it is not necessary to fill out an enrollment form.
Note: * Required Fields:
Customer Information
Please enter the following information to help us identify you and your accounts.
*First Name: Middle Name: *Last Name:
Business Name (if applicable):
*Social Security # or EIN #: *Date of Birth:
*City: *State: *Zip Code:
*Primary Phone: Secondary Phone: Mobile Phone:
*Email Address: *Re-enter Email Address:
Work Email Address: Re-enter Work Email Address:
*Mother's Maiden Name:
Note: For security reasons, if this information does not match Harleysville Bank records, we may not be able to process your online banking enrollment. Security Codes will only be directed to phone numbers or email addresses of record already on file with Harleysville Bank. (For businesses, the enrollment form and personal information must be filled out by an owner/signor)
Login Information
Please choose a Login ID that is a minimum of 7 characters in length and maximum of 10 characters. You may use a combination of letters and numbers. Each customer's Login ID must be unique and we cannot guarantee that you will be assigned your desired Login ID. If the Login ID you've chosen is not available, Harleysville Bank will supply an alternate Login ID for you.
*Desired Login Name:
Account Information
Please provide an account number and select the appropriate account type. All accounts in which you have ownership will be made available to you via online banking.
*Account Number *Account Type
Services Requested
Services marked with an asterisk (*) are for Business Use Only. Please indicate if you are interested in any of the following additional services and a Harleysville Bank Representative will contact you.
Remote Deposit * E-Statements Debit Card - enter account numbers below**
Wire Transfers * Access 24
ACH Origination * Tax Payments *

**Debit card not available on a savings unless a checking account is the primary account on the card.

Signature & Disclaimers:
By clicking the "Submit Enrollment" button below, I certify that the information above is correct and that I am authorized to enter into this agreement on behalf of the Consumer/Business Owning the accounts above. I understand that I am required to accept the Harleysville Bank Internet Banking Agreement and Disclosure during the User's first-time login. I agree that account security and access is controlled by our Login IDs and passwords. I warrant and guarantee all transactions performed using all Login IDs and Passwords are valid obligations of the Consumer/Business.
*Signature: *Date:
  (Type your full name)   (Today's Date)
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