Franklin eBranch, Franklin Bill Pay & TeleBanker Enrollment Form
Personal: Each account holder who wishes to use Franklin eBranch or Franklin Bill Pay must fill out enrollment form. For more than two people on an account, please fill out a second form.
Primary Account Holder Secondary Account Holder
Name

Address

Town

State Zip Code

Day Phone ext.

Date of Birth

Last 4 digits of your Social Security Number

Name

Address

Town

State Zip Code

Day Phone ext.

Date of Birth

Last 4 digits of your Social Security Number

Security: Choose one question and provide the answer.
Primary Account Holder Secondary Account Holder
Security Question

or Question of your choice (if this option was selected):

Answer (to either choice above)

Security Question

or Question of your choice (if this option was selected):

Answer (to either choice above)

Account: Each eBranch user should choose a single, unique account for the purpose of enrolling. Once you are enrolled, all your accounts will be available. If you are joint account holders and you only have one account at Franklin Savings Bank, a customer service representative will contact you.
Type

Account Number

Type

Account Number

Authorize: Each box must be checked.
I would like to enroll in Franklin Savings Bank’s Franklin eBranch, Franklin Bill Pay and/or TeleBanker program, which will allow me to access my above-listed accounts, and other accounts I may have now or in the future, in order to perform account inquiry, funds transfer functions and/or pay bills.  I am aware that new functions may be added at any time. 
If this allows access to a business account, all authorized representatives consent to this enrollment by signing below. 
By signing below business account owners authorize any account signers access to Franklin Bill Pay, thereby, allowing payments by check or electronic means to be processed to any person or entity. 
Transfers from a Money Market Deposit Account (MMDA) or Statement Savings Account to another account or to third parties by preauthorized or automatic transfer, including telephone transfer, are limited to six per statement cycle.
I consent to the fees disclosed to me at the time of this enrollment. I understand that those fees may change at the bank's discretion.
Everything here is true and correct to the best of my knowledge.
Primary Account Holder Signature:

Date: ______________________
Secondary Account Holder Signature:

Date: ______________________
Individuals will be enrolled in Franklin eBranch, Franklin Bill Pay and TeleBanker

Business Entities must check each service you choose to enroll in:
Franklin eBranch Franklin Bill Pay TeleBanker
Print and Mail: Drop by any branch or mail to:
Customer Service, Franklin Savings Bank, PO Box 825, Farmington ME 04938
For Bank Use Only:
Teller # _________ Branch # _________ Port # __________________
Signature/ID verified? Yes No
Log On instructions and fees explained to customer? Yes No