Mutual Benefits Enrollment Application

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Customer Information:

Select Account Package

Premier Perks & Protection

Perks & Protection


Consumer Terms & Conditions

I (We) understand that I will be debited on my monthly statement in the amount indicated per membership level selected. I also understand that I can end my membership and corresponding fee at any time. Perks & Protection and Premier Perks & Protection Members only: I (We) understand that I (We) will be covered by identity theft services 10 days after I have activated these services.

I (We) hereby accept The Merrimack’s offer to participate in the Mutual Benefits program offered by Generations Gold Inc., and to receive specified discounts on various services based on the membership level selected. I (We) agree to pay the monthly fee in accordance with the account disclosures and benefits package I (We) received. I (We) understand that The Merrimack makes no presentation, expressed or implied, regarding the quality of service and products provided by participants 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 (We) hereby authorize Merrimack County Savings Bank to release any information deemed necessary for participation in the Mutual Benefits program to Generations Gold, Inc. I (We) understand that the benefits and services are provided by Generations Gold, Inc., a fully independent benefits provider.