AUTO SAVE REQUEST

Complete and mail to:
Provident Bank
7210 Ambassador Road
Baltimore, MD 21244
Mailcode: 211

Customer Name: Date of Request:
Social Security No.: Telephone No.:

New Transfer Request Change to Existing Transfer Request FROM Account No. TO Account No. Account Type (Example: Checking, Savings, Money Market) Account Type (Example: Checking, Savings, Money Market) Amount to be transferred:     Beginning Date: Expiration Date: Transfer Frequency: Weekly Bi-weekly Monthly Quarterly Other

DeleteTransfer Request Delete existing transfer request between the following accounts: FROM Account No. TO Account No. Effective date of changes Amount of transfer

This authorization may be terminated at any time by the Bank at its sole discretion. By signing and dating this form, the account owner agrees to any conditions contained therein and as may be adopted from time to time. In the event that a transfer is scheduled to occur on a holiday or weekend, the transfer will be completed on the next business day. If funds are not available in the account being debited, the transfer will not occur. The account owner is subject to limitations on transfers as stated in the "Deposit Account Agreement and Disclosures for Consumer and Commercial Accounts" and fees set forth in the "Special Fees and Conditions for Consumer Accounts." I authorize Provident Bank to complete the above mentioned transfer until rescinded by me in writing. _________________________________________________________ Account Owner's signature _______________ Date _________________________________________________________ Branch Representative _______________ Branch

Form #1962 (1/98) Provident Bank (Bank 620)