First Security Bank - West
E-Statement Enrollment Form

 Customer Information
 Customer Information
Customer Name Including Suffix

Customer Name Including Suffix
Social Security Number

Social Security Number
DOB (mm-dd-yyyy)

DOB (mm-dd-yyyy)
Email Address
Email Address


 Checking & Savings Account
 Checking & Savings Account
Acct. No.
Acct. No.
Acct. No.
Acct. No.


 Customer Signature
 Customer Signature
Signature

Signature

Date

Date

Password
Password


By clicking submit you agree to the terms and conditions listed below

FIRST SECURITY BANK

Electronic Account Statement and Check Image Delivery Enrollment Agreement

FIRST SECURITY BANK Electronic Account Statement and Check Image Delivery Enrollment Agreement ("Agreement") governs use of the FIRST SECURITY BANK Electronic Delivery Service. As used in this document the words "you" and "your" refer to FIRST SECURITY BANK's customer(s) and their use of the Service. The words "we" and "our" refer to FIRST SECURITY BANK .

This agreement explains the terms and conditions governing the FIRST SECURITY BANK ELECTRONIC DELIVERY service offered through FIRST SECURITY BANK. By using the Service, you agree to the following terms and conditions. This Agreement will be governed by and interpreted in accordance with Federal laws and regulations, or to the extent there is no applicable Federal law or regulation,by the laws of the State of Minnesota or North Dakota as applicable. By accepting above or otherwise using the Service, you agree to use the Service only for bon fide and lawful purpose permitted under this agreement.

Terms & Conditions:
1. To receive Electronic Delivery Services, you must have a working connection to the Internet with e-mail capability to open Portable Document Format (.PDF) file with Adobe Acrobat Reader 8.0 or higher

2. Upon enrollment, periodic account statements, disclosures and notices will be provided electronically. These disclosures and notices may include: Online Banking Agreement and any amendments, periodic account statements, deposit account disclosures, lending disclosures, privacy policy, change in terms notices, notice of fee changes, fee schedules and other written notices required by law. You may request paper copies by sending your request to the address provide below.

3. At the time of this enrollment agreement, you agree to provide us with a password needed to decrypt the self-extracting attachment containing your information. The password that you provide to us must be alphanumeric with a minimum of six (6) characters. The password will be case-sensitive.

4. You agree to keep us informed of any change in your e-mail address by advising us in writing at the address provided below.

5. Upon receipt by us of an e-mail delivery error regarding the statement PDF file will result in the termination of this agreement. The information contained in the undelivered file will be mailed to you at the address contained in our records.

6. If we change the minimum hardware or software requirements, and you are unable to receive electronic delivery service, you will be released from this agreement without any penalty or consequence to you.

7. You may withdraw you consent for electronic delivery services by sending written notice to the address provided below. Upon withdrawal, the documents will be sent in paper form to your address of record. (You may be assessed a service charge for paper delivery. See your Truth in Savings Disclosure.)

First Security Bank - West
Beulah Branch, P.O. Box 69, Beulah, ND 58523
Robinson Branch, 212 Main St., Robinson, ND 58478

8. Following termination of the electronic delivery service by either party, a new enrollment agreement will be required to reinstate this service.

9. Upon transmission of the e-mail file to your e-mail address, you will have the sole responsibility for maintaining security of the e-mail including, but not limited to your e-mail provider and users of your personal computer or computer network. E-mail notice to one owner of a joint owner account is considered notice to all owners.

10. You further agree to indemnify and hold us harmless from and against any and all loss, cost, damage, liability, or exposure (including reasonable attorney's fees) that we or you may suffer or incur as a result of the unlawful use, unauthorized use, or misuse by any person of any such e-mail or electronic delivery of statements, disclosures or notices. You shall bear the entire risk for unauthorized use thereof whether or not you are negligent.

BY ENTERING YOUR NAME ABOVE, YOU AGREE TO THE TERMS AND CONDITIONS OF THIS ELECTRONIC ACCOUNT STATEMENT AND CHECK IMAGE DELIVERY ENROLLMENT AGREEMENT.


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