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eStatement Enrollment

Receive convenient and secure statement information when you need it.  With free eStatements you will no longer need to file and store paper at your home or in the office.  Not only is this environmentally friendly, but it reduces the risk of identity theft. 

In order to receive eStatements you MUST be enrolled in online banking.  If you are not enrolled in online banking, click here to enroll your personal or business account today.

 

* = Required Field

First Name:*

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Middle Initial:
Last Name:*

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Social Security Number/Business Tax ID Number:*

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Address:*

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City:*

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State:*

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Zip Code:*

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Date of Birth:*

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Home Phone:*

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Email Address:*

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Email Address Confirmation:*

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Online Banking Access ID:*

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Email Statements
Please send the following statement(s) via e-mail:
Checking Statement
Account Number:
Account Number:
Account Number:
Savings Statement
Account Number:
Account Number:
Account Number:
Loan Statement
Account Number:
Account Number:
Account Number:
Other

By completing this form, I authorize Denmark State Bank to deliver the above statement(s) via electronic mail. I also acknowledge that Denmark State Bank will not deliver the above statement(s) via traditional mail. Denmark State Bank will consider the statement delivered if no return e-mail is received. If, however, a return notice is received by the bank, a statement will be sent via traditional mail. You understand that it is your responsibility to notify us if your e-mail address changes. We will notify you by e-mail when your electronic statement is available for viewing. We also reserve the right to begin sending hard copies of your statement in the mail. Even though e-mail statement files are encrypted you acknowledge that the Internet is inherently insecure and that all data transfers, including electronic mail, occur openly on the Internet and potentially can be monitored and read by others. We cannot and will not warrant that all data transfers utilizing e-mail statements, or mail transmitted to and from us, will not be monitored or read by others. This agreement may be terminated by contacting Denmark State Bank in writing at: P.O. Box 130, Denmark, WI 54208-0130 or calling us at (920) 863-2161. Statements will be available for a period of 12 months via our Internet Banking System. After the 12 month period, you will need to contact us and request a copy of your statement. You understand that your statements will include information concerning both your share of deposit and loan accounts with the bank and may include disclosures required under the Truth-In-Lending Act, the Electronic Funds Transfer Act, the Truth-In-Savings Act and/or similar disclosure laws. You agree to the receipt of these disclosures in electronic format as described herein.

Your consent, which will be given by clicking on the “I AGREE” button below, is to authorize Denmark State Bank to forward to you electronically your periodic bank statements and other disclosures that the bank might send to you with your bank statement.

Note: You will receive the e-mail notification from Denmark State Bank Notification. Please remember to add notification@denmarkstate.com to your list of allowed senders.

For Internal Use  
Employee Name:
Date: