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Information Request Form
Consent to E-Statement Sign-up
This enrollment form asks for your consent so that we can provide monthly account statements
to you in an electronic format rather than a paper format. Before accepting below, please read the
following disclosures and requirements for accessing electronic disclosures.
Internet statements provide all information available on paper statements. An e-mail message
will inform you each month when your statement goes online. Images of checks for the month
can be easily accessed. Statements and check images will remain online on a secure First
National Bank site and may be downloaded or printed for permanent retention.
PLEASE NOTE: To access monthly account statements and disclosures electronically, you must
A First National Bank checking or savings accounts
An Internet connection
A 128-bit encrypted Web browser
Access to a printer or storage medium such as a hard drive so that you download and/ or
print disclosures and/or statements for your records
You must be able to open PDF files to enroll in this product. You will need Adobe
Acrobat Reader or another product for this purpose
If you're lacking any of these requirements and want to receive Internet Statements, please
contact us and we'll help get you set up.
If you change your mind about electronic disclosures and statements in the future: You can
always request paper copies. If a special need arises, we can prepare a paper-based version of
any of the electronic records you receive for up to five years after the date it was created. You
can change back to all paper based disclosures and statements. In order to change your disclosure
format from electronic to paper just contact us via any of the options shown above.
To update your electronic address or to change the method you have chosen to receive
information, electronically or on paper, or if you have any questions, e-mail us at
IBinfo@fnblasanimas.com or call us at 1-888-803-2672. You can also change your email
address through the Other Services Menu in our Internet Banking service.
By accepting below I certify that I have read the above disclosures and want electronic monthly
account statements. I have access to a computer that meets the technical requirements set forth
above, and I have access to a printer, or the ability to download information in order to keep
copies for my records. I will notify you of any changes in my electronic address, or if I no longer
want to receive disclosures electronically.