E-Statement Enrollment Form

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

Computer Requirements:

  • A computer with 28.8 kb Modem, or alternate Internet access point (DSL, cable)
  • Adobe Acrobat Reader 5.0 or higher
  • Internet browsing software: MS Internet Explorer 5.5 or higher with 128-bit encryption is recommended. Netscape 6.0 or higher can also be used
First Name: *
Last Name: *
Business Name:
If applying for a business account.
Address: *
City: *
State: *
ZIP * - Plus 4: -
Phone Number: * - -
Email: *
Please contact the bank if your e-mail address changes.
SSN/Tax ID: *
(of Account owner)

Activate the following accounts for E-statements:
Primary Account Number: *
 
Additional Account:
 
Additional Account:
 
Additional Account:
 
Additional Account:
 
Additional Account:
 
Additional Account:
 
Choose Your User Name: **
** Must be a minimum of 6 alphabetic or numeric characters, but no more than 20.

Terms of Agreement

Upon receipt of your consent, we will provide periodic statements 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 statement. It is your responsibility to protect your password from unauthorized persons. You agree that it is your responsibility to ensure that the electronic statements cannot be intercepted or viewed by others. You understand that you have no expectation of privacy if the statements 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 this agreement. You authorize the bank to send future statements for the above-mentioned accounts to the e-mail address listed above and to receive disclosures electronically. You understand that by authorizing this E-Statement Service you will no longer receive paper statements in the mail. You are responsible for notifying us of any e-mail address changes. Notification of any e-mail changes should be received ten (10) days before the end of your normal statement cycle.

You may notify us by e-mail a or by calling your branch office. If your electronic mail is returned as undeliverable an attempt will be made to contact you.

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

All electronic statements 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 statement service, and E-Statement program 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.

By submitting this form, I authorize the bank to send future statements for the above-mentioned accounts, for which I am an owner, to the e-mail address listed above and to receive disclosures electronically. I understand that by authorizing this E-Statement Service I will no longer receive paper statements in the mail.

Please print this disclosure for your records.
* Required Information