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.

Online Banking Enrollment Form:

To sign up for Online Banking, please complete, print, sign and mail in this Enrollment Form to the address below.

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.

Each account owner must complete a separate Enrollment Form to receive a unique Login ID and temporary password, and to have access to Online Banking. This Enrollment Form is to be completed for personal accounts only. Business account online access must be set up using the Business Enrollment Form.

For your security, you must log in within the first 60 days or your Login ID will be deleted.

Customer Information:

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

All fields must be completed in order to process your application.

Full Name:
Address:
City:
State:
Zip:
Phone (day):
Phone (eve):
E-Mail (required):
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.

Delivery Method Authorization:

Please select your preferred method for receiving your Login ID and temporary password. If no option is selected, the information will be sent by email.
Secure Email Letter

Account Information:

Please list below the accounts you want available in Online Banking and specify the appropriate access type* for each account.

Account Number and Access Type*:	Account Description: (Not required)	Account Type:

* Definitions for Access Types:

Full Access - You will have 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:

SIGNATURE: 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:	____________

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)