For proper processing please complete this online form, print out, and fax, mail, or deliver in person to:

Piscataqua Savings Bank Attn: e-bank services P O Box 568, Portsmouth, NH  03802-0568 FAX  #603-610-0500

Once we receive and approve your e-bank application, we will send your Username and Temporary Password by postal mail. This should take about 5 business days from the time we receive it.  Protect your Username and Password.  If you believe the security of your Password has been compromised, change it immediately and promptly notify us. You must maintain a valid Piscataqua Savings Bank NOW Checking account to sign up for and use this service.  If you close your NOW account, or go 60 days inactive using the e-bank,  your access will be terminated.     First Name MI Last Name Address City ST Zip Home Phone Bus. Phone E-Mail Date of Birth Social Security Number Primary NOW Checking Account Number   Sign me up for Piscataqua e-bank at no charge (allows me to view my deposit accounts and make transfers between them) I also want online bill payment service at no charge.  See the  Bill Payment Terms & Conditions for more information.

We must have this information to establish Piscataqua e-bank access. You must be an owner on all other accounts you wish to access.

I hereby make application for Piscataqua e-bank service and agree to authorize transfers and, if selected, bill payments. I accept all risks associated with this service except as otherwise specifically provided in Federal or State laws and regulations.  I acknowledge receipt of PSB’s Online Access Agreement, Bill Payment Terms & Conditions,  and Electronic Funds Transfer Agreement/Disclosure contained within and agree to all terms and conditions set forth therein, which may be changed from time to time by PSB.

Please provide the answers to any 2 of the security questions below for telephone identification purposes.

Mother's  Maiden name?

Favorite color?

Favorite date?

City Born in?

Signed		Date