eBank Enrollment

Thank you for expanding your relationship with Bath Savings Institution. If you have any questions during the process, please feel free to contact us at 1-800-447-4559 during regular business hours, fill in the comment section of the form, or send us a secure email.

You must click the "I Accept" button to continue with the online banking services application. If you click "I Decline" button, you will be returned to BathSavings.bank

eBank Enrollment Form

Required fields are marked by an *

First Name: *
Middle Initial:
Last Name: *
Social Security Number: *	- -
Home Phone: *	- -
Work Phone:	- - Ext:
Mailing Address: *
City: *
State: *
Zip: *
Mother's Maiden Name?: *
Security Key, In what city were you born?: *
Email: *
Confirm Email: *

Please select one or more of the following electronic banking services:

	Telephone Banking Access
	Please choose a 4 digit numeric PIN:
	This number will be used as your telephone banking PIN.
	Online Banking Access
	Please choose a temporary password: *
	Temporary password must be 9 characters long and must contain: One(1) Capital letter; One (1) lower case letter; One number; One (1) special character (!, @, #, $, %, &, *).
	This password will be used as your electronic banking password the first time you log in.
	Online Banking Access with Bill Pay
	Online Banking with Bill Pay- account will be charged $5.00 per month after 60 day trial. One account will be automatically enrolled.
	(No Charge with e-statement Accounts, eChecking NOW Accounts, or Packard Now Accounts).
	Additional accounts may be added upon request.

Primary Account Number: *
This number is to be used for the first time log on.

Electronic Statement Delivery

		I would like e-statements for all accounts. (Checking, Savings, CD, loans)
	OR
		I would like e-statements for only the accounts listed in the boxes below. (If you need more space, please use the comment section.)
	NOTE: You must be the primary account holder to authorize the eStatement delivery on the account.

Account Numbers:

Questions or Comments?

Please use the space provided below for any comments, questions, or additional information. Thank you.

Signature: By signing this application, I acknowledge that I have read and accepted the terms and conditions set forth in the Electronic banking disclosures, Internet Banking Agreement and Bill Payment Agreement and agree to be bound by their terms. I further authorize the bank to issue a temporary Access ID on my behalf which I will be forced to change to a private Access ID first time I log into the system. I understand that if six (6) months elapse without my loggin into my online banking profile, the access will be deactivated and I must enroll again if I wish to have online banking access.

I hereby acknowledge that I have read and understood the above statement.

BANK USE ONLY
Portfolio #	Primary Account #	Enrollment Date
Name Line #	Statement Cycle Code	Enrolled By
Online enrollement may be delayed until any inconsistent information has been verified.
Information requiring verification:
Email Address
Mailing Address
Telephone #
Mothers Maiden Name
City Born In
Social Security #
None
Contact Made By
Date of Contact
Time of Contact
Comments