ESIGN Consent to Receive Account Statement Electronically

By completing this form, you agree to receive your periodic account statements electronically for your requested accounts. Please read the instructions carefully, and do not hesitate to call or stop by the Bank should you have any questions.

Hardware and Software Requirements

To receive this information electronically, you will need:

• A computer or other device with Internet access
• A personal email address
• Adobe Acrobat Reader software

To retain this information, you will need:

• A printer (for printed copies)
• A hard drive or other storage device (for electronic copies)

Availability of Paper Records

You may choose to receive monthly disclosures in paper form.  The cost for this service will vary, depending upon the type of account you currently have. If at a later date, you wish to obtain paper copies of these disclosures, call 785-742-2101.  You will be required to describe the records you desire, and a fee of $1.00/page will apply. 

Withdrawing Consent for Electronic Delivery

You have the right to withdraw consent for electronic delivery at any time.  To withdraw consent, you must call 785-742-2101.

Your Electronic Address 

In order to receive electronic statements, you must provide us with a working email address

You must notify us of email address changes by calling 785-742-2101.  Call us at least 5 working days before your next scheduled disclosure date. 

Completing your sign-up

After you have read and completed this form, please click the button below.  We will send an email message to the address you have entered above.  This message will contain instructions for competing your enrollment for this service.   

Fields marked with a * are required fields for form submission.                 

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