Sign up for Online Banking and Bill Payment for Personal Accounts

Personal Banking Online Banking Enrollment Form
If you are a Middlesex Savings Bank customer, simply complete and return the enrollment form to access your personal accounts on our online banking service, and to pay bills from your checking account. Once your enrollment form is received, we will assign a Login ID and temporary password. Identify which accounts you would like to access, and what level of access you would like for each account.

Online Banking Enrollment Form:

To sign up for Online Banking, please complete, print, sign and mail the Enrollment Form to:

Middlesex Savings Bank
Online Banking Department
PO Box 5210
Westborough, MA 01581-5210

In a few days, you will receive an Online Banking Login ID and a temporary password that you must use to log into the Online Banking System. The first time you log in, you will be required to change your password.

For your security, you must log in within the first 60 days or your Login ID will be deleted. Activated Login IDs will be locked after 60 days of non-use.

This Enrollment Form is to be completed for personal accounts only. Business account online access must be set up using the Business Enrollment Form.

Customer Information:

New User: Request Online Banking authorization for the first time.
Modification: To make changes to an existing user profile.

Full Name:
Address:
City:
State:
Zip:
Phone (day):
Phone (eve):
E-Mail:
Social Security Number:
Mother's Maiden Name:

Requested Services:

Online Banking with Bill Payment: Access account balances, transfer money, and pay your bills from your checking account at no additional cost!

Online Banking only: Conduct common banking tasks online.

Account Information:

Please list below the accounts you want to access in Online Banking.

Account Number and Access Type*:	Account Description: (as you identify this account) Not Required:	Account Type:
1
2
3
4
5
6
7
8

* Definitions for Access Types:

Full Access - You will have the full access available on this account.
View & Deposit - You may view account information and transfer funds into this account.
View Only - You will be able to view balances and transactions.
Deposit Only - You will be able to transfer funds into this account from other accounts with Full Access. You will not be able to view balance or transaction information.

Authorization:

SIGNATURES: By signing below, I request and authorize access to the above accounts through the Online Banking Service. I authorize Middlesex Savings Bank to issue a temporary password on my behalf which I am required to change to a private password the first time I log into the Online Banking Service.
SIGNATURE:	_________________________	DATE:	____________
JOINT ACCOUNT HOLDERS:
JOINT ACCOUNT HOLDER NAME:	_________________________
SIGNATURE 2:	_________________________	DATE:	____________
JOINT ACCOUNT HOLDER NAME:	_________________________
SIGNATURE 3:	_________________________	DATE:	____________

Please print this form and send to:

Middlesex Savings Bank
Online Banking Department
PO Box 5210
Westborough, MA 01581-5210

1-877-INFO CTR (1-877-463-6287)