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Benefits Plus® Enrollment Application

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Applicant Information

Tennessee State Bank's Security Information

Tennessee State Bank is dedicated to the protection of its customers' privacy. All personal and financial information submitted through the Tennessee State Bank website will be kept accurate, secure and will be shared only as disclosed in our Privacy Policy or as authorized by you.

Tennessee State Bank operates with a secure network, which will recognize communications from customers using browsers that are compliant with certain security standards.

Supported Browsers – Current and Prior Major Release – when a new version is announced as Release to Web (RTW), support will cease on the third-oldest major version.
Internet Explorer – (IE) 11 & Microsoft Edge
Safari – Apple/Mac Users only
Google Chrome

Consent & Acceptance of the Electronic Delivery of Terms & Conditions.  Please review before filling out secure form,  adobe acrobat reader is required to view PDF file.

Please fill out this secure form.
First Name*:
Middle Initial:
Last Name*:
Home Phone Number*:
E-mail Address*:
Checking Account Number*:

PASSCODE for the secure form is listed within the Consent & Acceptance of the Electronic Delivery of Terms & Conditions and is used to ensure that the customer has read, understood, and agrees to the terms and maintains a copy of the disclosure for their records.

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I hereby accept Tennessee State Bank's offer to participate in the Benefits Plus® program offered by Generations Gold, Inc., and to receive specified discounts on various services.

I understand that I am receiving a complementary 90-day trial membership to Benefits Plus®. After the 90-day trial period, I may continue receiving Benefits Plus® for a low membership fee of $6 per month. This fee will be automatically drafted from my account on the first statement cycle following the end of the 90-day trial period. I understand that to discontinue my membership and avoid being charged a membership fee, I can visit any TSB branch any time before the end of the 90-day trial period. I understand that enrollment in the Benefits Plus® program may be cancelled at any time.

I understand that this financial institution makes no representation, expressed or implied, regarding the quality of service and products provided by other vendors associated with Benefits Plus® offered by Generations Gold, Inc. and shall have no liability in connection therewith. All liabilities, claims, damages and demands are the sole and direct responsibility of Generations Gold, Inc. and its independent benefits providers. I hereby authorize this financial institution to release any information deemed necessary for participation in the Benefits Plus® Program. I understand that the benefits and services are provided by Generations Gold, Inc., a fully independent benefits provider.

I understand that all account owners, including our minor children up to the age of 18 residing in our household, will be automatically enrolled in the Identity Theft & Security Center Program, featuring Restoration Rescue®. By clicking "Submit" below, I acknowledge that I have received, understand and accept the Terms & Conditions of the program provided by Generations Gold, Inc. as provided to me in the Consent & Acceptance of the Electronic Delivery of Terms & Conditions. I understand that the Terms and Conditions are subject to change at any time and that I am responsible for periodically reviewing the Terms and Conditions as provided at www.benefits-plus.org.

As the applicant of this membership, I understand that to benefit fully from my membership, I and all account owners on my account must activate membership by enrolling at www.benefits-plus.org or by calling 1.866.329.7587.

By clicking on the "Submit" button you are agreeing to accept the offer to participate in the Benefits Plus® Program offered by Generations Gold, Inc. Once the Enrollment Application is submitted, you cannot edit it any longer.

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