Overdraft Protection Form

If you would like North Country Savings Bank to authorize and pay overdrafts on ATM and everyday debit card transactions, complete the form below and hit submit. You can also:

Complete the form, print it, and fax it to us at 315-386-5798
Complete the form and bring it to one of our five convenient locations
Call us at 800-356-7709 to register your selection

You may change your overdraft protection designation for your account(s) at any time. Please note that your selection to OPT IN requires that you meet qualification criteria to be eligible for our Overdraft Privilege program. The change is not immediate.

I OPT-IN and authorize North Country Savings Bank to pay overdrafts on my ATM and everyday debit card transactions for the account(s) listed below.

I OPT-OUT and do not authorize North Country Savings Bank to pay overdrafts on my ATM and everyday debit card transactions for the account(s) listed below.

PLEASE ENTER ONLY THE LAST 4 DIGITS OF EACH ACCOUNT NUMBER. Your account number is available on your monthly statement, or on your checks.

Consumer Checking Account 1

Consumer Checking Account 2

Consumer Checking Account 3

Consumer Checking Account 4

Consumer Checking Account 5

First Name

Last Name

Your Mailing Address

City

State

Zip

Email Address

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