Community State Bank [ Electronic Signup ] Providing banking needs for Central Iowa in 10 locations, Altoona, Ankeny, Des Moines, Johnston, Pleasant Hill, Waukee

Electronic Statement Application

If you prefer to print this form instead of submitting it online, use the Print command on your browser's File menu. You can bring your application in to Customer Service at any one of our 10 locations, or mail your application to:

Please sign your name below which constitutes approval of, and agreement to, be bound by the terms of the Online Banking Agreement and all supporting disclosures.

Signed ___________________________________

Items marked with an asterisk (*) are required.

* First Name / MI: * Last Name: * E-mail Address:		* Checking Account #: * Savings Account #: * Mother's Maiden Name: (for security purposes)

I would like to sign up for Electronic Statements (requires at least one account number) E-sign Consent Paper Statements By signing up for the Service you recognize that you will no longer receive paper statements or returned checks in the mail. However, at any time you may request to have the Service discontinued by calling our Customer Care Department. Although the Service is free, you may incur additional fees if you discontinue the Service and request a return to paper statements and have your checks returned via regular mail. While you are enrolled in the Service, you may also request a paper copy of your statement. However, you may be charged a fee. To avoid fees, E-Statements are printable and downloadable using the .PDF format. Applicable Accounts This consent applies to any and all accounts you access via the E-Statement web site. How to discontinue service To withdraw from the E-Statement service call the Community State Bank Customer Care Department at 515-331-3100, or stop by any Community State Bank branch office. How to Update Your Information In order to provide notification to you when your E-Statements are available, we must have your current e-mail address. If you would like to modify any personal information or change which accounts can be used with the E-Statement service, please stop by any Community State Bank branch office. To change your password, log into the E-Statement service. System Requirements: In order to access the E-Statement Service, you will need a PC, an Internet service provider and a modem with a baud rate of at least 28,800 for acceptable performance. Your web browser must support 128-bit encryption Secure Socket Layers (SSL). Acceptable browsers are: • Netscape Navigator 4.0 or higher, with optimal performance at 4.0+ • Microsoft Internet Explorer version 4.0 or higher, with optimal performance at 4.0+ • America Online software for Windows version 4.0+ Note: If you are using America Online software it is mandatory that you use either Netscape Navigator or Microsoft Internet Explorer as your web browser for optimal viewing. From time to time we will conduct system software & hardware upgrades. Should any of these upgrades impair your ability to view and or manage E-Statements as you did prior to the upgrade, you have the option of withdrawing from the E-Statement program without penalty. However, it is possible that you would incur monthly fees to have your checks mailed to you. Joint Account Holders If you are the owner of multiple accounts, you may have those accounts activated for E-Statements. Remember, when you activate E-Statements your paper statements stop coming to you in the mail. If you give your password to others who are named on the account with you, they will be able to see all accounts for which you have E-Statements activated. As stated previously, we do not recommend that you share your password. Regulations & Disclosures You may print these regulations and disclosures if you want to have a paper copy. If you cannot print these regulations and disclosures and wish to have another copy, one will be emailed to you. You can request this by sending an email to our Customer Care Department or by calling 515-331-3100. Electronic Consent By clicking on "I Agree" below you consent to receiving your statements electronically. You also confirm that you are able to access all information related to E-Statements in an electronic form. I agree


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