The First State Bank Columbus, TX
Electronic Statement Application
Sign up for Electronic Statements
Before you submit the eStatement Application, you must read the Electronic Statement Terms & Conditions. By choosing to submit the eStatement Application, you are agreeing to the terms, conditions, and fees set out in the Electronic Statement Agreement.
Account Name: _______________________________________________
State: ____________________________ Zip: _____________________
Home Phone #: ______________________________________________
Work Phone #: ______________________________________________
Cell Phone #: ________________________________________________
Email Address (Primary): ______________________________________
Email Address (Secondary): ____________________________________
Account Number/Numbers: _____________________________________
I have received, read and agree to the terms, conditions and fees set out in The First State Bank's Electronic Statement Terms & Conditions. I understand my rights and obligations as a consumer of the eStatement service. I also understand the rights and the obligations of The First State Bank as the provider of these services.
Printed Name: ________________________________________________