ATM Card Application

Applicant Account Information

Primary Checking Account Number*
*This must be a checking account product. It may not be a Money Market account due to transaction limitations.
Secondary Checking AccountNumber(s)
Primary Statement Savings Account Number
(Passbook and CD Accounts are not eligible)
Secondary Statement Savings Account Number(s)
If you simply wish to add additional accounts to an existing card please check here and list the accounts below.
Additional Account Number(s)

Applicant Personal Information

Salutation
First Name*
Middle Initial
Last Name*
Date of Birth (mm/dd/yyyy)*
Social Security Number*
Home Phone*
Address*
City*
State*
Zip Code*
E-Mail Address*
A 24-Hour banking Card Agreement will be mailed to you. Before using your Dedham Savings 24-Hour Banking Card, please review the Card Agreement and Fee Schedule for important information regarding your card.

By pressing the Submit button, you agree that the Bank may obtain credit references it deems necessary, including but not limited to a credit reference provided by a check verification service.
I have read and understand my rights as described above.*