Farmers State Bank - E Statement enrollment form

E-Statement Enrollment

Enjoy the convenience of less paperwork and minimizing your impact on the environment by signing up for E-Statements. Simply fill out the information below and return this form to start enjoying the benefits of paperless statements.

Please print and return form.

Name on Account:

Account Numbers:


Email Address:

Additional email address optional:

Preferred Daytime Contact Phone Number:



Contact Phone Numbers:

Home:

Work:

Cell:

I have read and agree to the Farmers State Bank of Hamel E-Statement and Electronic Disclosure Terms and Conditions.

^{Customer Signature} ^Date
^{Form 11/08}