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2018 Pilot Program Registration
FOR FINANCIAL INSTITUTIONS
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Thank you for your interest in BankSafeTM. Getting involved in this 12-state pilot program will put your financial institution at the forefront of this effort to protect vulnerable account holders from elder financial exploitation.


To register for the BankSafeTM pilot program, please complete the following information.

*response required


1.Contact information for person completing Registration information:
First Name:*  
Last Name:*  
Email:*  
Phone [###-###-####]:*  

2.*Name of financial institution:
 

3.*Location(s) of financial institution:
(Note that it must be in at least one of the following participating states.)

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If you have any questions or technical difficulties while taking this online survey, please contact:
Scott Myers // Support Specialist
rsurveyhelp@readexresearch.com // 651.439.8207651.439.8207 // 800.873.2339 x8207800.873.2339 x8207
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