Enrollment Form

First Name Middle Name Last Name

Email Address Phone Number

Address City State Zip

Account Number to be debited for Monthly Fee

Option 1 ID TheftSmart Basic (Credit Monitoring)	Option 2 ID TheftSmart Plus (Credit Monitoring +idINTEGRITY Scan)
Coverage:	Single Bureau Credit Monitoring	Individual
Services:	ID Theft Counseling ID Theft Restoration	ID Theft Counseling ID Theft Restoration
Monitoring:	Experian	TransUnion, Equifax, Experian	Scanning of Personal Identifiable Information
Added Services:	Notification of: √New accounts opened √Payment Delinquencies √Credit Inquiries √Public Record Changes √Change of Address (US Mail or Email)	Notification of: √New accounts opened √Payment Delinquencies √Credit Inquiries √Public Record Changes √Change of Address	Address Aware-Monitoring of address at USPS Web Watcher-Scanning of personal information on the Dark Web Personal Persona-Scanning of credit header data (Available by Email only)

Please choose from the following options available to you:

Peoples Bank and its employees, agents, or any of its affiliated or related organizations disclaims all express or implied warranties or representations of any kind or nature whatsoever of its merchantability of the ID TheftSmart Consultation/Restoration program provided by Kroll Advisory Solutions. You specifically agree, on your behalf and on behalf of your heirs, executors and assigns, not to bring any legal action in any federal or state court or other court of law or equity against Peoples Bank or any of its affiliated or related organizations under any theory of liability and further agree to indemnify and hold Peoples Bank and its affiliated or related organizations harmless. These Terms and Conditions and your access to, use and browsing of the Site are governed by Iowa law without regard to its conflict of law provisions.

Peoples Bank may cancel your membership at any time due to non-payment. We will provide you with notification prior to cancellation. You may cancel membership to this program at any time by written notification to Peoples Bank, 1230 Valley Dr, Rock Valley, IA 51247. I understand that with my enrollment in a credit monitoring or identity scanning program the authentication of my identity is required before I will receive any alerts.

I understand that I have received the above terms and conditions and I am enrolling as an individual at least 18 years of age in the above selected ID TheftSmart option and understand my account listed above will be debited a monthly amount based on the option I choose.

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Customer Signature	Date	Peoples Bank Member FDIC

Bank Use

Location CSR

Membership Number

10/18-CRT