Email Statement Enrollment Form

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

Please Select One   Receive email reminder to get your statement through EZ Online Banking (Internet Banking)
  Receive statement as an Adobe Acrobat PDF with a password protecting the file. 
Password

Needs to be at least 8 letters, numbers, or special characters (!, #, *) or a combination of each. Letters are case sensitive.
First Name
Last Name
Business Name If applying for a business account.
Address
City
State
Zip Code
Home Phone Number - -
Work Phone Number - -
Email    Please contact the bank if your e-mail address changes.

SSN/Tax ID
(of Account owner)
 

Activate the following accounts for Email Statements:
Primary Account Number
 
Additional Account Number
 
Additional Account Number
 
Additional Account Number
 
Additional Account Number
 
Additional Account Number
 
Additional Account Number
 
 

Terms of Agreement

By signing below, I authorize the Farmers State Bank of Waupaca to deliver the above statement(s) via electronic mail. I also acknowledge that the Farmers State Bank of Waupaca will not deliver the above statement(s) via traditional mail. Farmers State Bank of Waupaca will consider the statement delivered if no return email is received. If however, a return notice is received by the bank, a statement will be sent via traditional mail.

I understand it is my responsibility to notify the Farmers State Bank of Waupaca if my email address changes. Even though Email Statement files are encrypted, I acknowledge that the Internet is inherently insecure and that all data transfers, including electronic mail, occur openly on the Internet and potentially can be monitor and read by others.

Farmers State Bank cannot and will not warrant that all data transfers utilizing Email Statements, or mail transmitted to and from us, will not be monitored and read by others. This agreement may be terminated by contacting in writing: Farmers State Bank, Attn: Bookkeeping Dept, 112 W. Fulton Street, Waupaca, WI 54981.

Please print this disclosure for your records.