Telephone Banking Application

Co-owner (if joint account):
Zip Code:
Home Phone:

Work Phone:

Please list all checking or savings accounts that you wish to have transfer capabilities through PWSB telephone.
Account Number 1:
Account Number 2:
Account Number 3:
Account Number 4:
Account Number 5:
Account Number 6:

Authorization Agreement:
I authorize Port Washington State Bank to provide telephone access to my accounts listed herein through PWSB's Telephone until revoked by me in writing and received by Port Washington State Bank, 206 N. Franklin St., Port Washington WI 53074

I will not hold Port Washington State Bank responsible or liable for failure or refusal to honor my requests through Port Washington State Bank's Telephone or for damages caused by an unauthorized person who may have had access to my personal identification number (PIN), consistent with the rules and regulations governing this agreement as set forth in the telephone rules and regulations. I understand for this reason that Port Washington State Bank strongly recommends that I change my PIN to a personalized code.

Agreement of the above allows Port Washington State Bank to combine statement cycles of the transfer accounts.

By execution of this agreement, I(we) acknowledge receipt of the rules and regulations governing PWSB's Telephone and agree to be bound by the terms and conditions thereof.