Please use the following form to apply for Bill Pay from Security State Bank.  Please review the terms & conditions set forth in Security State Bank's Bill Pay Agreement & Disclosure prior to completing the application.



*First Name:
*Last Name:
Middle Initial:
*Address:
*City:
*State:
*Zip Code:
Home Phone:
Work Phone:
Fax:
*Email:

You received a Regulation E-Disclosure (electronic funds transfer agreement and disclosures) at the time of opening your account. Would you like another copy sent to you?

   No       Yes


I have viewed, read, and agree to the terms and conditions set forth in Security State Bank's Bill Pay Agreement & Disclosure. I understand my rights and obligations as a consumer of the Bill Pay service. I also understand my rights and obligations of Security State Bank as the provider of this service.

   I agree

 

     



     Telephone 218-263-8855   800-819-0839    Telebanc 218-263-2222 



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