SHAZAM Chek . . . The card that's like SHAZAM Chek Card...SHAZAM ®Chek may look like a credit...

SHAZAM®Chek may look like a credit card —but it's not! It's a new concept in checking.It's an electronic card that you can use like anATM card or like a check to make cashpurchases wherever you see the SHAZAM®,MASTERCARD®, or CIRRUS® symbols.

LEAVE YOUR CHECKBOOK AT HOME ...SHAZAM®Chek replaces writing a check byallowing you to access your checking accountelectronically rather than writing a check. Oryou can use it like an ATM card to accessyour checking and savings account.

NO HASSLE CHECKING ...Paying with SHAZAM®Chek eliminates delaysand check approvals.

TOTAL CONVENIENCE ...because SHAZAM®Chek is easy to carry, it'salways with you, everyday — at home oraway. It's safer than cash.

BETTER RECORD KEEPING ...with SHAZAM®Chek you receive a receipt ofeach transaction and your monthly checkingaccount statement lists all of your transactionsfor reconciling your account.

Farm

ers Trust &

Savings Bank

101 North M

ain PO

Box 507

Buffalo C

enter, IA 50424

SHAZAM®Chek . . .The card that's like

having your checkbookand ATM card

all rolled into one!

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Return A

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Personal__________ Business__________ Employee__________

SHAZAM®Chek Card ApplicationPLEASE PRINT INFORMATION BELOW:

Last Name (Cardholder) First Name MI Soc. Sec. No. Birth Date

Last Name (Cardholder) First Name MI Soc. Sec. No. Birth Date

Mailing Address City State Zip Code

Home Phone Number Work Phone Number

This card should be linked to my checking account number for purchases at merchants and ATM use:

This card should be linked to my savings account number for ATM access only:(The savings account can only be linked if you link your checking)

Please read the following carefully before signing:

AGREEMENT OF DISCLOSUREI (We) agree that the bank may rely on the accuracy of the above information, and is authorized to obtain and verify/ my (our) credit history, bankreferences, employment, and any other information permitted by law to determine my (our) credit worthiness.

If my (our) SHAZAM®Chek card is damaged, lost or stolen, I (we) will be required to pay a replacement fee of $10.00 per card.

Cardholder Signature Date Joint Cardholder Signature Date

( ) ( )

Complete thisapplication and return it to

Farmers Trust & Savings Bankby refolding so the bankaddress is on the outside.

FOR FINANCIAL INSTITUTION ONLY:

ACCOUNT NUMBER NO. CARDS ORDERED EXPIRATION DATE

ACCOUNT NUMBER NO. CARDS ORDERED EXPIRATION DATE

UNMANNEDDELUXE INPUT MCS INPUT

DAILY POS

3-DAY LIMIT

DISCLOSURES INPUT VERIFIED