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Information Request

Use this form to request information, ask questions or send comments. Please include your email address. Other sections are optional.

If your browser does not support forms, email us your information at info@jssb.com.

Name
First

Last


Business/Company Information
Business/Company Name
Business Address - Line 1
Business Address - Line 2
City
State
Zip
Business Phone Number

Business Email Address


Individual Information
Home Address - Line 1
Home Address - Line 2
City
State
Zip
Home Phone Number

Home Email Address


I Am Interested In Information About:
 Checking:
Checking Account

Savings:
Investment Savings
CD's
IRA's
Other Interest Bearing
      Accounts


Corporate Information:
Quarterly Report
Annual Report
 Loans:
Mortgage Loan
Home Equity Loan
Auto Loan
Other Loan

Other Banking Services:
Credit Card
MAC/ATM
Check/Debit Card
Contact Me By:
Email U.S. Postal Mail
Have a Representative Call Me

By answering the following questions, you will help us better structure this site and our services to meet your needs.
 Are you a Jersey Shore State Bank Customer? Yes No

How do you use the Internet?
Personal
Business
Email
Other

Would you conduct banking transactions on the Internet?
Yes No
If so, what type of transactions?
Obtaining Balances
Making Payments
Transferring Money
Other (specify)

Why would you not conduct business on the Internet?
Security Concerns
Cost
Lack of Software
Online Services Not Offered

What type of computer system are you using?


Comments/Questions
Please do not provide confidential information in this comment area.



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