Overdraft Protection Form - First Mid Bank & Trust

Please tell us how we can help you so we can serve you better! Please select an option below and provide the requested information so that we can update our records accordingly.

Email
This field is for validation purposes and should be left unchanged.
Authorization*
- YES, I WANT First Mid Bank & Trust to authorize and pay overdrafts on my ATM and everyday debit card transactions.
- NO, I DO NOT want First Mid Bank & Trust to authorize and pay overdrafts on my ATM and everyday debit card transactions.
Name*
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Email*
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Daytime Phone#*
Checking Account Number
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Checking Account Number
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Checking Account Number
Last Four Digits
Checking Account Number
Last Four Digits
Checking Account Number
Last Four Digits
Checking Account Number
Last Four Digits
Checking Account Number
Last Four Digits
Checking Account Number
Last Four Digits
Checking Account Number
Last Four Digits