Deposit Account Application,
Temporary Signature Card and Agreement

Must be resident of Massachusetts

Service Fees | Truth in Savings Policy
Electronic Funds Transfer Policy
Deposit Products | Home Page

49 Main Street, P.O. Box 388
Natick, MA 01760
Telephone (508) 653-2340

Instructions: 1. Please print out and return the completed form by mail or fax to: Customer Service Department Natick Federal Savings Bank P.O. Box 388 Natick, MA 01760 Fax (508) 655-9313 (If you mail this form, you may enclose your initial deposit) 2. Upon receipt of your account application, we will mail to you a signature card for you to complete and return (with your initial deposit if you did not send it with the application), our Funds Availability, Electronic Funds Transfer, Truth in Savings Disclosures, and a Schedule of Service Charges.

Web Site Deposit Account Application and Temporary Signature Card
Type of Account __ Statement Savings __ NOW Checking __ Money Market Checking __ Passbook Savings __ Basic Checking __ Money Market Passbook __ CD with _____ months term			Ownership of Account __ Individual __ Joint Tenants __ In Trust for * (specify) ______________________
Account Owner(s) Name & Address Name (1) __________________________________________ Street ____________________________________________ City ____________________________ St ___ Zip ________			Tax ID _______________________ Date of Birth __________________ Home Phone __________________
Name (2) __________________________________________ Street ____________________________________________ City ____________________________ St ___ Zip ________			Tax ID _______________________ Date of Birth __________________ Home Phone __________________
* Name & Address of Beneficiary: In Trust for Name ____________________________________________ Street ____________________________________________ City ____________________________ St ___ Zip ________			Tax ID _______________________ Date of Birth __________________ Home Phone __________________
Certification of Taxpayer Identification Number (TIN) Under penalties of perjury, I certify __ The number _____________________________ is my correct TIN. __ I am not subject to Backup Withholding either because I have not been notified that I am subject to Backup Withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to Backup Withholding. __ I have been notified that a signer is subject to Backup Withholding due to a payee underreporting and has not received notice from the Internal Revenue Service that Backup Withholding has been terminated. __ I am not a United States citizen or resident. Date _________________________ Signature: ________________________________________________
Signature(s) The undersigned hereby agree to 1) the terms stated on this form, 2) have read as provided on this web site and agree to the Schedule of Service Charges, Funds Availability, Electronic Funds Transfer and Truth in Savings Disclosures and acknowledge that copies will also be sent to the address of signer #1 upon the bank’s receipt of this Deposit Account Application and Signature Card and 3) authorize this institution to obtain consumer reports from consumer reporting agencies or others in connection with this account.
Signature (1) _____________________________________		Signature (2) ___________________________________
Date _____________________________________	Date ___________________________________

Terms: I (We), the aforesigned, hereby apply for a membership and an account in the Natick Federal Savings Bank and for the issuance of evidence thereof. Specimen(s) of my(our) signature(s) is (are) shown on the above form and the Bank is hereby authorized to act without further inquiry in accordance with writings bearing any such signature(s); it being understood and agreed that any of the aforesigned who shall first act shall have power to act in all matters related to the membership and the above applied for account, whether other person(s) named are living or not. You are authorized to supply any endorsement for me(us) on any check or other instrument tendered for this account, and, you are hereby relieved of any liability in connection with collection of such items which are handled by you without negligence and you shall not be liable for the acts of your agents, sub-agents or others or for any casualty. Withdrawals may not be made on account of such items until collected, and any amount not collected may be charged back to this account, including expense incurred, and any other outside expense incurred relative to this account may be charged to it. The withdrawal or redemption value of the above applied for account or other rights relating thereto may be paid or delivered in whole or in part to any of the aforesigned, who shall first act, and such payment or delivery or a receipt or acquittance signed by any of the aforesigned shall be a valid and sufficient release and discharge of said Bank. It is hereby understood that interest and/or dividends when and as declared shall be credited to this account.