E-Statement Enrollment Form

To sign up for E-Statements you must be an owner of the Frazer account(s) you have chosen for E-Statements. You must complete the information below and click the "I Accept" button.

Computer Requirements:

A computer with internet access
Adobe Acrobat Reader 7.0 or higher
Valid Email Account

Personal Information

First Name: *
Last Name: *
Business Name:	If applying for a business account.
Address: *
City: *
State: *
ZIP* - Plus 4: *	- plus 4
Phone Number: *	- Phone - Phone
Last 4 digits of SSN/Tax ID: * (of Account owner)
Email: *	Please contact the bank if your e-mail address changes.

Account Information

Choose E-Statement Options

Send an Additional Copy of the encrypted email attachment to:

Statement/Notice is delivered via Internet Banking
Statement/Notice is delivered via encrypted email attachment

Password to open
statement/notice: *

Passwords are case sensitive, can be alpha
or numeric and 6-10 characters in length.

Name:

Email:

Password to open statement/notice:

Passwords are case sensitive, can be alpha
or numeric and 6-10 characters in length.

Account Numbers

Account Number: *

Account Number:

Sweep Confirmation Notices

Account Number

Verification of Request:
Account Number for verification: *
Amount of Last Deposit on this account: *
Special Instructions
Please note: If the requested information below is not completed, we will not be able to fulfill your request

Terms of Agreement

Upon receipt of your consent, we will provide statements/notices (hereafter referred to as "document") to you on a monthly or quarterly basis, as applicable, to a working e-mail address that you have provided us. You will be required to use a password to view the electronic document. It is your responsibility to protect your password from unauthorized persons. You agree that it is your responsibility to ensure that the electronic document cannot be intercepted or viewed by others. You understand that you have no expectation of privacy if the documents are transmitted to another e-mail address, selected by you, such as an employer or relative. You further agree to release the bank from any liability if the information is intercepted or viewed by unauthorized parties at this other e-mail address selected by you.

By submitting this form, you agree to the terms of the agreement. You authorize the bank to send future documents for the above mention accounts to the e-mail address listed above and to receive disclosures electronically. You understand that by authorizing this E-Delivery Service you will no longer receive paper documents in the mail. You are responsible for notifying us of any e-mail address changes. Written notification of any e-mail changes should be received ten (10) days before the end of your normal statement cycle.

If your electronic document is returned as undeliverable an attempt will be made to contact you by phone or US Mail to obtain a new e-mail address. If we are unable to obtain a valid e-mail we will cancel your E-Delivery service and your document will be delivered via US Mail to the mailing address we have on file. If that document is returned we will put it on hold.

Please note: In the future, if you want to stop using the E-Delivery service, please contact your branch office. Please notify us at least ten (10) days before the end of your normal statement cycle.

All electronic documents shall be in full compliance with applicable laws and regulations. The provisions in the agreement are part of (and in supplement to) the bank's Terms and Conditions for Depository Accounts. Each bank account that you designate to be included within the E-Delivery Service is also governed by the terms and conditions otherwise applicable to the kind of account as separately disclosed to you, either in the Terms and conditions for Depository Accounts, applications and enrollment forms, the applicable personal or business fee schedules, credit or deposit agreements, our Privacy Policy or other written disclosures.

YOU UNDERSTAND AND INTEND THAT YOUR CLICKING ON THE "I ACCEPT" BUTTON SHALL OPERATE AS YOUR ORIGINAL SIGNATURE. BY CLICKING ON THE "I ACCEPT" BUTTON, YOU ALSO ACKNOWLEDGE THAT;

You can access, receive, and retain notices electronically in the formats we use, and affirmatively consent to the receipt of notices electronically;
You have the necessary computer hardware, software, and internet access to send and receive the necessary e-mails;
You expressly consent to the use of electronic records for the electronic delivery of your statements, notices, and any disclosures or other communication sent to you;
You are authorizing Frazer Bank to replace documents with electronic versions;
You are consenting on behalf of all other co-owners and/or authorized signers to enroll the accounts you have selected in the service, and that you are authorized to consent on their behalf;
You are authorized on behalf of the Organization (if applicable) to make this request to enroll accounts for the service;
You have read and understand the Terms of Use, and have printed or downloaded a copy for your records

Please print this disclosure for your records.

Authorization

Step 1 - Read Agreement

View Frazer Bank's Electronic Statement Disclosure

Step 2 - Authorization

By checking this box, I acknowledge that I have read and understand the Electronic Statement Disclosure Agreement. *

You must complete this step before proceeding to Step 3 and submitting

Step 3 - Verification

Enter Verification Code from printed document here: *

Without entering the verification code your form will not be submitted.

*Required Information