Benefits Plus® Enrollment

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Consent to Electronic Delivery of Documents and Consent to Participate in Benefits Plus. Please review before filling out secure form, adobe acrobat reader is required to view PDF file.

* Indicates Required field.

First Name*

Middle Initial

Last Name*

Address*

City*

State*

Zip*

Home Phone Number*

Email Address*

Checking Account Number*

Confirmation Code*

The Confirmation Code for the secure form is listed within the Consent to Electronic Delivery of Documents and Consent to Participate in Benefits Plus 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.

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 complimentary 90-day trial membership to Benefits Plus®. After the 90-day trial period, my Benefits Plus® membership will continue for a Benefits Plus® Membership fee of $8.00 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 if I am a Veteran and I present Form 214 to TSB, I will not be charged a monthly Benefits Plus® Membership Fee.

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 or call TSB Operations at (865) 453-7011. I understand that enrollment in the Benefits Plus® program may be cancelled at any time.

The monthly Benefits Plus® Membership Fee of $8.00 will apply whether or not you activate, enroll or utilize the benefits or services available in your membership. See benefits-plus.org or call (866) 329-7587 for complete program details.

I understand that Tennessee State Bank has selected Generations Gold, Inc. a fully independent third party benefits provider, to provide discounted services directly to Benefits Plus® members. Tennessee State Bank assumes no liability for any of the providers in fulfilling their services. All liabilities, claims, damages, and demands are the sole and direct responsibility of Generations Gold, Inc. and its independent service or benefits providers. Discounts received through the Benefits Plus® program may not be used in conjunction with any other discounts. Benefits and services available through the program are subject to change without notice. Benefits and services may be subject to additional enrollment, restrictions and limitations or may incur an additional cost. Not all plans and discounts are available in all areas. See benefits-plus.org or call (866) 329-7587 for complete program details.

I hereby authorize Tennessee State Bank 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.

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 to Electronic Delivery of Documents and Consent to Participate in Benefits Plus. 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 (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.

Submissions of the Enrollment Application form other than Monday-Thursday, 8:00 am – 5:00 pm (ET) and Friday, 8:00 am – 6:00 pm (ET), excluding Federal holidays, are considered received on the next business day.