JSSB - Internet Banking Application

APPLICATION
CONSUMER INTERNET BANKING

To enroll in Jersey Shore State Bank Internet Banking,
your computer browser must support 128 bit encryption.

Print this form. When finished click here.
Internet Explorer: RIGHT CLICK on this page and select "Print".
Netscape: Select "Print" from the "File" menu.
Complete this form. Sign and submit by postal mail to the address below.

Thank you for choosing Jersey Shore State Bank Internet Banking. Internet Banking applicants must currently have established deposit or loan accounts at Jersey Shore State Bank. All depositors or loan customers on each account to be accessed must sign this application.

FEES:

Internet Banking:
No Charge (account related fees still apply)

Optional Bill Payment: This is a FREE service with an unlimited number of transactions. This service can be used with a checking account only. Savings and Insured Money Market accounts do not qualify.

DEFINITIONS:
"You" and "Your" mean each of the depositors or loan customers described above. "Us", "We" and "Our" mean Jersey Shore State Bank. "Internet Banking" refers to the services provided by us, from time to time, which can be accessed by you via the Internet. "Services" refers to information provided, rates, products, balance transfers, bill payment services and any other services we offer for which you are approved. Our current service provider is Jack Henry & Associates, Inc.

APPLICATION:
Please complete the following information. Information indicated by an asterisk (*) must be completed. Other information is optional.

We reserve the right to accept or deny any application for Internet Banking or Bill Pay. You agree that you will receive a password and Personal Identification Number, Internet Banking Agreement, Privacy/Security Principles, Electronic Funds Transfer Disclosure and Question and Answer document if we approve this application. You agree that use of the password and Personal Identification Number constitute proof that you have received, read and understand the foregoing. You are responsible for your PIN and any transactions conducted by you or another authorized user.

You agree that access to Internet Banking will require a password and Personal Identification Number and, under some circumstances, additional information for security purposes. This information will be provided to you by return mail.

We can only accept this application with original signature(s), either delivered in person, by U. S. Mail at 300 Market Street, P. O. Box 967, Williamsport, PA 17703, Attn: Computer Operations Department, or by fax to (570)-322-7920. We cannot accept signature(s) via E-mail.

INTERNET BANKING


Is this a New Application?     YES      NO

If making changes to an existing application, 
    enter the Internet Banking ID#                
    and check one option below.
            Add to
            Delete
            Other

Personal Information

*Your Social Security Number/Business TIN:                                 

*Your Name:                                                                
                     Last                   First          Middle    Suffix
					 
*Or, Business Name:                                                        

*Your Physical Address or Location:

                                                                           
         Street or RR Number                     House or Box Number
		 
                                                                           
               City                          State                Zip

*Your mailing Address: (if different from above)

                                                                           
         Street or RR Number                     House or Box Number
		 
                                                                           
               City                          State                Zip
			   
*Your Phone Number:                                                        

*Your E-mail Address: (if applicable)                                      


For Security Purposes Only:

*Your mother's maiden name (last name only):                               

*Businesses Create a Code Word:                                            

Other Account Owners Requesting Internet Banking ID#s:

Name:                                                                      
             Last              First        Middle    Suffix    Soc. Sec. #

Name:                                                                      
             Last              First        Middle    Suffix    Soc. Sec. #

Name:                                                                      
             Last              First        Middle    Suffix    Soc. Sec. #

ABOUT YOUR ACCOUNTS:
You must list the loan and deposit accounts which you want to view account information or conduct other business regarding the account as offered through the Internet Banking product. You may include names by which you refer to your accounts. For instance, you may wish to call "Account #00001-D" your "checking" or "bills" account, or whatever other name you use to refer to it. These names are called "Pseudo Names" and blanks for listing them are provided below.

You may also elect to have all of your accounts accessible. You can do this by selecting "all loan and deposit accounts", but if you want to name the accounts with "Pseudo Names" you will need to list them below or change them via the "Management" tab on the Internet Banking product any time you visit the site.


You wish to access the following accounts through Internet Banking:

             All Loan and Deposit Accounts
             All Deposit Accounts
             All Loan Accounts

		 
Account #             Pseudo (Alternative) Name
                      (Name of accounts as you want them to appear on screen
											Optional, 20 characters, no punctuation)

Bill Payment Information: (Optional)
This is a FREE service with an unlimited number of transactions.

This service can be used with a checking account only. Savings and Insured Money Market accounts do not qualify.

Account bills will be paid from Account #

By completing the account number above, you are authorizing us to provide you with the "Bill Payment" option and deduct the amount of your Bill Payment transactions from the above-mentioned account. If you discontinue use of this Bill Payment Option, you will need to notify us in writing. If we amend or discontinue your Bill Payment account, we will notify you.

PLEASE NOTE: ANY PAYMENT MADE THROUGH THE BILL PAYMENT® SERVICE REQUIRES SUFFICIENT TIME FOR YOUR PAYEE TO CREDIT YOUR ACCOUNT PROPERLY. TO AVOID THE IMPOSITION OF FINANCE CHARGES OR OTHER CHARGES BY THE PAYEE, YOU MUST AUTHORIZE AND SCHEDULE A PAYMENT ON A DATE THAT IS SUFFICIENTLY IN ADVANCE OF THE DUE DATE OF YOUR PAYMENT. JERSEY SHORE STATE BANK SHALL NOT BE RESPONSIBLE FOR ANY CHARGES IMPOSED OR OTHER ACTION TAKEN BY A PAYEE RESULTING FROM A LATE PAYMENT, INCLUDING BUT NOT LIMITED TO, FINANCE CHARGES AND LATE FEES.

A transaction may take up to seven (7) business days to reach the vendor either by check or electronic means.

If any accounts listed are joint accounts, each owner is required to sign before Internet Banking access will be given.


                                                                            
                      Signature                                  Date

                                                                            
                      Signature                                  Date

                                                                            
                      Signature                                  Date

                                                                            
                      Signature                                  Date