Bank by Phone using Tele-BaNK...

Danville State Savings Bank

Telephone Banking Service -- TeleBaNK

(319) 392-8265 or toll-free (877) 392-8265

FUNDS TRANSFER AUTHORIZATION REQUEST

As used in this authorization, "I", "We", "Us" means the owners of the accounts identified below. "You" and "yours" means the depository institution named above.

I authorize and direct you to set up the following accounts for Funds Transfer on Danville State Savings Bank's 24 hour Customer Service Line.
I understand that a maximum of 12 accounts may be listed for Funds Transfers.

Accounts to be set up for Funds Transfers:
(Please do not list CDs or IRA accounts. Accounts of these types are accessible by TeleBaNK for inquiry only.) The first account which is listed will be the one which is used (it's PIN) for Funds Transfers.

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___________________________________
Signature of Authorized Party

___________________________________
Signature of other Authorized Party
(If Applicable)

_______________________________(___/___/___)
Printed Name and Date

OPTIONAL:Your E-mail address or any other private information will only be used for communications from Danville State Savings Bank and will not be released to any third party.)

Telephone number:_________________
E-mail:__________________

***NOTE: FUNDS TRANSFERS OCCURRING AFTER 12:00 NOON WILL BE PROCESSED ON THE NEXT BUSINESS DAY.

If you have questions or need assistance in using our Tele-BaNK service, please call (319) 392 - 4261 or toll-free (877) 392 - 4261