PHONE: 864.638.5444

FAX: 864.638.2425

www.BRBWal.com

P.O. BOX 889

Walhalla, SC 29691

 

 

 

 

 

BRB ENROLLMENT FOR BILL PAY

 

To complete your enrollment for Bill Pay, please complete and return the form below. This document may be dropped off at any of our 3 locations, faxed to (864) 638-2425, or mailed to PO Box 889, Walhalla, SC 29691. Additionally, you may email this form to customerservice@brbwal.com; however, this form must be signed and scanned into a .pdf document.

 

Unfortunately, the SC Department of Revenue database breach has forced us to change certain procedures. As a part of this process, we are taking necessary security measures to prevent unauthorized access to our customers’ personal data. We apologize for any inconvenience these additional steps may cause.

 

First Name:

 

Last Name:

 

Address:

 

City:

 

State:

 

Zip Code:

 

E-mail Address:

 

Account Number:

 

Home Phone:

 

Cell Phone:

 

 

 

______________________________________ _______________________

Customer Signature Date

 

 

For your protection the account holder’s signature will be verified before Online Banking will be activated.