Were you a participating Basic Banking for Massachusetts financial institution in 2016?

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* 1. Were you a participating Basic Banking for Massachusetts financial institution in 2016?

Please type the name of your financial institution as you would like it to appear on our website:

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* 2. Please type the name of your financial institution as you would like it to appear on our website:

I certify that my financial institution has BOTH a qualified Basic Banking for Massachusetts Checking Account and a Basic Banking for Massachusetts Savings Account. This means the accounts meet all of the following criteria.

Basic Banking Checking Account Guidelines:
- Requires no more than $25.00 to open the account
- Charges a monthly fee of no more than $3.00
- Provides at least 15 free withdrawals, including at least eight (8) checks, per month
- Charges no more than $1.00 for each withdrawal over the allowable number of free withdrawals

Basic Banking Savings Account Guidelines:
- Requires no more than $10.00 to open an account
- Charges no monthly fee on account balances of $10.00 or more
- Charges a monthly fee for no more than $1.00
- Pay interest on all account balance of $10.00 or more

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* 3. I certify that my financial institution has BOTH a qualified Basic Banking for Massachusetts Checking Account and a Basic Banking for Massachusetts Savings Account. This means the accounts meet all of the following criteria.

Basic Banking Checking Account Guidelines:
- Requires no more than $25.00 to open the account
- Charges a monthly fee of no more than $3.00
- Provides at least 15 free withdrawals, including at least eight (8) checks, per month
- Charges no more than $1.00 for each withdrawal over the allowable number of free withdrawals

Basic Banking Savings Account Guidelines:
- Requires no more than $10.00 to open an account
- Charges no monthly fee on account balances of $10.00 or more
- Charges a monthly fee for no more than $1.00
- Pay interest on all account balance of $10.00 or more

I certify that my financial institution has a qualified Basic Banking for Massachusetts Checking Account ONLY. This means the account meets all of the following criteria.

Basic Banking Checking Account Guidelines:
- Requires no more than $25.00 to open the account
- Charges a monthly fee of no more than $3.00
- Provides at least 15 free withdrawals, including at least eight (8) checks, per month
- Charges no more than $1.00 for each withdrawal over the allowable number of free withdrawals

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* 4. I certify that my financial institution has a qualified Basic Banking for Massachusetts Checking Account ONLY. This means the account meets all of the following criteria.

Basic Banking Checking Account Guidelines:
- Requires no more than $25.00 to open the account
- Charges a monthly fee of no more than $3.00
- Provides at least 15 free withdrawals, including at least eight (8) checks, per month
- Charges no more than $1.00 for each withdrawal over the allowable number of free withdrawals

I certify that my financial institution has a qualified Basic Banking for Massachusetts Savings Account ONLY. This means the account meets all of the following criteria.

Basic Banking Savings Account Guidelines:
- Requires no more than $10.00 to open an account
- Charges no monthly fee on account balances of $10.00 or more
- Charges a monthly fee for no more than $1.00
- Pay interest on all account balance of $10.00 or more

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* 5. I certify that my financial institution has a qualified Basic Banking for Massachusetts Savings Account ONLY. This means the account meets all of the following criteria.

Basic Banking Savings Account Guidelines:
- Requires no more than $10.00 to open an account
- Charges no monthly fee on account balances of $10.00 or more
- Charges a monthly fee for no more than $1.00
- Pay interest on all account balance of $10.00 or more

Our financial institution does NOT have any qualified Basic Banking for Massachusetts accounts at this time.

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* 6. Our financial institution does NOT have any qualified Basic Banking for Massachusetts accounts at this time.

Please indicate the name and contact information for the person to whom we should address Basic Banking correspondence.

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* 7. Please indicate the name and contact information for the person to whom we should address Basic Banking correspondence.

Please provide the name and contact information for an additional contact, if applicable.

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* 8. Please provide the name and contact information for an additional contact, if applicable.

Thank you so very much for participating in this *green* alternative to a paper mailing!

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