Northside Community Bank

Electronic Banking Application

Customer Name: *
Business Name:
Date of Birth:*        
Last 4 digits of SS# :*
(of Account owner)
Mothers Madien Name:*
ZIP* - Plus 4: -
Home Phone Number: *
Business Phone Number: *
Cell Phone Number: *
Email Address: *
Confirm Email: *
Please provide electronic access to the following:
eXPRESS Banking   e-Statement    Bill Pay
Checking Accounts:
Savings / Certificates of Deposit / IRA Accounts
Loan Accounts

You desire to subscribe to the Services and authorize NorthSide Community Bank, and any other third party acting on Our behalf, to serve as Your agent in processing payments to targeted Merchants and/or transfers to and from targeted account pursuant to Your payment and/or transfer instructions, and You authorize Us to post such payment and/or transfer to Your designated account(s). You understand that We may not take certain payment and/or transfers if sufficient funds are not available in Your designated account. This authorization is in force until revoked by You or Us in writing and is subject to the service Terms and Conditions (a current copy of which will be furnished to you) as amended from time to time. Please refer to our Privacy Policy Statement on our website,

Your consent to receive e-Statements covers the periodic statements you are provided in connection with your NorthSide Community Bank deposit account(s). By using e-Statements, you accept and agree to be bound by the general terms and conditions governing e-Statements, including without limitation all the terms and conditions in this Agreement. You agree to be bound by any and all laws, rules, regulations and official issuances applicable to e-Statements now existing or which may hereafter be enacted, issued or enforced, as well as such other terms and conditions governing the use of other facilities, benefits or services that NorthSide Community Bank may from time to time make available to you in connection with e-Statements.

NorthSide Community Bank has absolute discretion to make e-Statements available to you. Further, NorthSide Community Bank has the discretion from time to time and upon giving notice to you to modify, restrict, withdraw, cancel, suspend or discontinue e-Statements without giving any reason and you understand that by using e-Statements after any modification or change has been effected, you would have agreed to such modification or change. All future statements for that account will be e-Statements which you will access through NorthSide Community Bankís Internet Banking to obtain, review, print, and copy/download your periodic deposit account statements. Each month we will send an email notice to you advising you of the availability of your e-Statement. Your electronic statement will be available for viewing for a period of twenty-four (24) months (or such period as decided by NorthSide Community Bank and notified to you) from the applicable statement date.

Scope of Consent for Electronic Delivery of Notices

Your consent to receive electronic notices covers any notice or other type of communication provided to you pursuant to the terms of this Agreement. We will send all notices, attachments, and/or documents via e-mail to the last known e-mail address provided by you. You agree to notify us promptly of any change of your e-mail address.

NorthSide Community Bank e-Statement Procedures

You must enroll each of your deposit account(s) for which you want to access e-Statements. Your e-Statement for your next statement cycle should be available for viewing the business day after your statement date. You will receive an automated notification email shortly after the end of each statement period informing you that your e-Statement is ready for viewing. In order to access your e-Statements, you must log in to NorthSide Community Bankís Internet Banking service and select the statement you wish to see.

Requesting to Receive or Cancel Paper Statements in Addition to e-Statements

Should you wish to receive paper statements or to cancel your request to receive paper statements in addition to e-Statements for a particular account contact the bank in writing to 5103 Washington Street, Gurnee IL 60031 to request the cancellation. Please also contact the bank in the event of a Change of Mailing Address, Email Address, and Other Information.

You agree to notify us immediately of any change in your mailing address, e-mail address or other particulars relevant to this Agreement. Please note that you must provide us with an e-mail address in order to use the e-Statement service.

Joint Accounts

If your NorthSide Community Bank account is owned jointly with another person, either one of you may consent to receive electronic disclosures and e-Statements and that personís election to access e-Statements shall apply to both of you. NorthSide Community Bank will automatically turn off the paper statement for that account after the first e-Statement has been made.


You agree that NorthSide Community Bank shall not be held liable if you are unable to gain access to the website or NorthSide Community Bank Internet Banking system from time to time. You understand that some or all of the e-Statement services and/or other NorthSide Community Bank system services may not be available at certain times due to maintenance and/or computer, communication, electrical or network failure or any other causes beyond NorthSide Community Bankís control. You understand the importance of your role in preventing misuse of your accounts and you agree to promptly examine your e-Statement for each of your NorthSide Community Bank accounts as soon as you can access it. You must report any errors or discrepancies in accordance with our Account Disclosure as provided to you and with applicable law.

Your User ID and password that are used to access Internet Banking services should be kept confidential. The password must be changed at least every ninety (90) days. You are responsible for keeping your password, account numbers and other account data confidential.

Change in Terms

The Bank reserves the right to change the terms and conditions of this agreement at any time, which includes the addition and deletion of e-Statement services.

Your Right to Withdraw Consent

You have the right to withdraw your consent to have your statements provided in an electronic form by contacting the bank in writing at 5103 Washington Street, Gurnee IL 60031. We will then discontinue e-Statement service for that account and you will receive paper statements for subsequent statement periods. Once this is done, previous e-statements will no longer be available.

Disclaimer of Warranty and Limitation of Liability

We make no warranty of any kind, express or implied, including any implied warranty of merchantability or fitness for a particular purpose, in connection with the e-Statements provided to you under the Agreement. We do not and can not warrant that the e-Statement service will operate without error, or that the e-Statement service will be available at all times. Except as specifically provided in this Agreement, or otherwise required by Law, you agree that our officers, directors, employees, agents or contractors are not liable for any indirect, incidental, special or consequential damages under or by reason of any services or products provided under the Agreement or by reason of your use of the e-Statement service, including loss of profits, revenue, data or use by you or any third party, whether in an action in contract or tort or based on a warranty or any other legal theory. NorthSide Community Bank makes no warranty that:

  • The service will be uninterrupted, timely, secure or error-free
  • The service will meet your requirements
  • The results that may be obtained from the use of the service will be accurate or reliable
  • The quality of any products, services, information or other material purchased or obtained by you through the service will meet your expectations

NorthSide Community Bank shall not be liable for any direct, indirect, incidental, special, consequential or exemplary damages, including but not limited to, damages for loss of profits, goodwill, use, data or other intangible losses resulting from:

  • The use or the inability to use the service
  • The cost of procurement of substitute goods and services resulting from any goods, data information or services purchased from the service
  • Unauthorized access to your transmission
  • Unauthorized alteration of your data
  • Statements or conduct of the third party service provider
  • Any other matter relating to the service

*Required Information