Overdraft Form

Opt in / Opt out Form

Required Field *

I do not want Farmers & Merchants State Bank to Authorize and pay overdrafts on my one-time debit card transactions.

I want Farmers & Merchants State Bank to authorize and pay overdrafts on my one-time debit card transactions.

I do not want Farmers & Merchants State Bank to implement the ComfortZone overdraft limits of $500 on my Farmers & Merchants State Bank checking account after being open for 90 days.

I want Farmers & Merchants State Bank to implement the ComfortZone overdraft limits of $500 on my Farmers & Merchants State Bank checking account after being open for 90 days. I have an ongoing right to revoke this consent by calling 920-478-2181, visiting the website www.fandmstbk.com or visiting either office in Waterloo or Marshall.

Name*

Date*

Last Four Digits of Account Number:*

Account 1

Account 2

Account 3

Account 4

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