Overdraft Services Disclosure and Consent Form

Complete all information below and click "Submit":
You must list the last 4 digits of your account number for each account you choose to have us authorize and pay overdrafts.

Right to Revoke Consent
If you have given your consent to have Farmers State Bank authorize and pay overdrafts on ATM and everyday debit card transactions, you may revoke that consent at any time by notifying Farmers State Bank at:

131 Tower Park Dr. Suite 100
Waterloo, IA 50701-9374

or 1-877-372-1879

If this is a joint account, any one of the account holders may revoke the consent on behalf of the other account holder(s).