Apply for a Debit Card or eStatements

Required Field

What are you applying for?

Debit Card
eStatements

Applicant

Name Mailing Address City State Zip Code Home Phone Number Work Phone Number Social Security Number Birth Date E-mail Address

Debit Card Application Information

Checking Account # Savings Account # (Optional)

Debit Card Authorization

By signing below, I agree to be bound by the terms and conditions of the debit card, and the electronic funds transfer disclosure, (SEE DISCLOSURE) Receipt of terms and conditions, and disclosure, and acceptance of such terms will be conclusively presumed by use of the card.

I acknowledge reading the disclosures. Signature Date

eStatement Application Information

Please list all account numbers you wish to generate.

Account Number

 Add Another Account

If you wish for a Professional Third-Party to receive your eStatements:

I, the customer, give person for the below Professional Third-Party to have access to my statements. The access will include all past and future statements until permission is revoked in written form to the bank. Third Party Phone E-mail

eStatement Authorization

ESTATEMENT WEB ACCESS INFORMATION WILL BE SENT TO YOU IN A WELCOME EMAIL.

By returning this form to us, you agree to receive your listed statements in an electronic form. You have the right at any time to withdraw your consent for electronic statements by notifying us in writing, in person, or by email of your intent to receive your statements on paper. You may request any previous electronic statement to be printed on paper at no charge. Additional accounts may be added by notification in writing, in person, or by email. Address all requests to the Bookkeeping department or IT department.