Make The Switch Checklist



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Make The Switch Checklist Moving all your accounts to North Salem State Bank has never been easier! Simply refer to the following guide to make your switch easy and convenient. For assistance, contact any of our team members at 765-676-5100 or stop by any convenient location. We re here to help every step of the way! To close an account and transfer any remaining funds, Recent bank statement with your old account number(s) Form #1 Account Closing Notification Follow up to ensure all checks have cleared on your old account Double check maturity dates if transferring a Certificate of Deposit in order to avoid possible penalties To change your payroll or direct deposit, Recent bank statement with your old account number(s) Form #2 Direct Deposit Request To change your Social Security Direct Deposit, Visit http://www.ssa.gov/deposit/how tosign.htm or call 1-800-772-1213 to change your direct deposit To change your automatic payment or withdrawal, Recent statement from vendor Form #3 Automatic Payment Request You will need to complete a separate form for each vendor that debits money from your account To move your online payments and/or set up North Salem State Bank Bill Pay, Recent statement from vendors Form #4 North Salem State Bank Payment Checklist To discuss transferring an existing loan, Recent loan statement with loan account and balance remaining Form #5 Loan Transfer Worksheet To transfer a 401k (or other retirement account), Recent account statement Contact information for your employer or former employer

Form 1 Account Closing Notification Please accept this letter as authorization to close my account(s) with your institution. Please close the account(s) listed below. To: Bank Name Bank Address Bank City Bank State, Zip Please send any remaining funds in the accounts listed to the following address: North Salem State Bank, PO Box 97, North Salem, IN 46165 Deposit Instructions: Deposit entire amount to checking account number: OR Deposit $ to savings account number: AND the remainder to checking account number: From: Name Address City State, Zip Telephone Number Social Security Number I authorize: The listed entity to close the account(s) listed here. The transfer of my funds to my North Salem State Bank checking and/or savings account(s) as indicated. North Salem State Bank to credit deposits to my account(s) as specified.

Form 2 Direct Deposit Request Please accept this letter as notification that I have established a new checking and/or savings account at North Salem State Bank. I would like my paycheck to be automatically deposited to my North Salem State Bank account according to the instructions below. To: Payroll Department Employer/Company Name: _ From: Social Security #: Please Attach a NSSB Voided Check Here. Subject: Payroll Direct Deposit Date: Establish Direct Deposit Change my existing Direct Deposit Deposit Instructions: Deposit entire amount to checking account number: OR Deposit $ to savings account number: AND the remainder to checking account number: North Salem State Bank Routing Number: 074908688 I authorize: The listed employer/company to change deposits of my funds to my North Salem State Bank checking and/or savings account. North Salem State Bank to credit deposits to my account(s). This authorization to remain in effect until I send written notice of change or cancellation.

Form 3 Automatic Payment Request Please accept this letter as notification that I have established a new checking and/or savings account at North Salem State Bank. I would like the following payment to be automatically debited from the North Salem State Bank. Establish Automatic Payment Change my existing Automatic Payment Automatic Payment Information: Company Name: Company Account #: Payment Amount: $ Personal Information: Name: Mailing Address: City: State: Zip: Daytime Phone Number: Bank Account Information: Account Type: Checking Savings North Salem State Bank Account #: North Salem State Bank Routing Number: 074908688 I authorize: The company listed to initiate withdrawal of my funds from the above North Salem State Bank account. North Salem State Bank to debit funds from my account. This authorization to remain in effect until I send written notice of change or cancellation.

Form 4 Payment Checklist We ve made it easy to move all your online payments to Bill Pay! Just use this helpful checklist to remember all the online payments you currently have. If you don t already have online payments set up to any of the vendors below, now is the time to do so! Bill Pay is a powerful tool for managing monthly payments. Mortgage/Rent Cable/Satellite TV Home/Renter s Insurance Auto Club (AAA, Onstar, etc.) Auto Loan/Lease Memberships (Health Club, Magazine subscriptions, etc.) Auto Insurance Credit Card Health/Life Insurance Department Store Credit Cards Electricity/Gas Company Loans (Personal, Student, RV, HELOC, etc.) Water Transportation/Parking Oil Company Savings/Investments/Annuity Payments Home/Cellular Phone Other Long Distance Other

Form 5 Loan Transfer Worksheet Use this worksheet to list all of your current loans. * For assistance and to complete the loan application process, please contact a North Salem State Bank loan officer at 765-676-5100 or stop by any convenient location. 1. 3. 2. 4. * Subject to credit approval. This worksheet does not take the place of a North Salem State Bank loan application. Please contact a North Salem State Bank loan officer to apply for a loan.