Eagle Premium Line of Credit Application First Name* Last Name* Phone Number*Email* PA Resident Only Disclosure* I verify that I am a Pennsylvania resident The Eagle Premium Line of Credit is only available for current Pennsylvania residents. Please verify above that you are a resident of Pennsylvania. E-SIGN DISCLOSURE AND CONSENT This disclosure is being provided by Susquehanna Community Bank. Before we may proceed with the Online Account Opening Product, it is necessary for us to provide the following information as required by the Federal Electronic Signatures in Global and National Commerce Act (“ESIGN”). In order to proceed and conduct business electronically, your consent to this agreement is required. By accepting the terms of this consent, you agree to open your account and receive documents electronically. Please read this Federal ESIGN Disclosure and Consent carefully and retain a copy for your records. Consent By selecting the “I accept” button to the disclosures within the Online Account application, you are consenting to utilization of the Online Account Opening Product, as well as the ability to access, receive, and retain all required disclosures and documentation required to open the account and all future loan or deposit accounts with Susquehanna Community Bank. Your consent to this agreement allows the use of electronic records and signatures. Along with your consent, you must provide a valid email address and must meet specific system requirements as outlined below. You agree that, in order to open the account, we will not provide you with paper copies. After your account is opened, you may request paper copies of all documents, free of charge, by contacting us at 570-568-6851. If additional information is required, but cannot be provided to you in electronic format, we will provide this to you in writing. System and Hardware Requirements You must have the following items in order to use the service: • A personal computer; • An operating system such as Windows 7, Windows 10 or Macintosh OS 10.x; • An internet browser, such as Microsoft Internet Explorer, Microsoft Edge, Firefox, or Safari, with a minimum 128-bit encryption for accessing the internet; • Access to the internet through your internet service provider (ISP); and • Software to access Portable Document Format or “PDF” files, such as the latest version of Adobe Acrobat Reader® available for download at http://get.adobe.com/reader. If hardware or software requirements change, we will notify you of these changes and the new requirements. Withdrawal of Consent You have the right to withdraw your consent at any time. By declining or withdrawing this consent, you will be unable to proceed with the application process. If you decide to withdraw this consent at a later date, such as after your application is approved or your account is opened, please us at 570-568-6851. If you do so, you revoke the right to receive electronic records in the future. How to Update Your Records It is your responsibility to provide us with true, accurate, and complete contact information. If there is a change in your email address or other information needed to contact you electronically, you agree to promptly contact us to update this information. This information may be submitted to: Susquehanna Community Bank, 940 High St, West Milton, PA, 17886 or by calling us at 570-568-6851. Revised 4/16/2019 Certification of E-Sign Disclosure* I accept I certify that I have read the above and agree to the E-Sign Disclosure and Consent. Application Instructions Just one more step! Please complete, sign, and return your completed Eagle Premium Line of Credit Application within 7 business days. All account owners (including joint owners) must sign the Application. The Application will display after clicking "SUBMIT" below. If you are unable to complete the Application at this time, please print or save the Application to complete at your convenience. You will not be able to return to the Application after you have closed the web page. We will accept a photograph of the Application via our website, as long as all information is clear and legible. We will also accept the documents by mail, fax, or delivered to one of our branches. Mailing Address: Susquehanna Community Bank Attn: Online Accounts Department 940 High Street West Milton, PA 17886 Fax Number: (570) 568-8136 Once we receive your completed and signed Application, we will begin processing your loan request. If we do not receive the Application from you within 7 business days, we will consider your request for an Eagle Premium Line of Credit to be void. If you have any questions, please feel free to contact us at (570) 568-6851 or by email at email@example.com. Please click "SUBMIT" below to continue to the application. Thank you!NameThis field is for validation purposes and should be left unchanged.