Electronic Statement Enrollment Application

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In order for you to access and view your electronic statement, you must have internet access, Adobe Reader, and an email account. Adobe Reader can be downloaded at no charge at www.adobe.com.

You must be a direct owner of the checking/savings account(s) to complete this form.

*Name (First M. Last):
*Social Security Number:
*Date of Birth (mm/dd/yyyy):
*Address:
*City, State Zip:	,
*Primary Phone Number:
Secondary Phone Number:
*Account Number(s):

*E-mail Address:
*Confirm E-mail Address:
*PIN: (Must be alphanumeric with a minimum of eight (8) characters. The PIN will be case-sensitive.)

Agreement and Disclosures

I understand that I will no longer receive a paper statement by U.S. Postal mail.

I understand that I will be sent a notice of the availability of my periodic account statement electronically using the email address I provided.

I understand that I will be required to access the First National Bank in Pinckneyville (FNB) website and login to Electronic Statements with my user ID and password in order to view my electronic statements and images.

I understand that the security of my PIN, User ID and Password is my responsibility and I agree not to disclose these to anyone not authorized by me to view my account information. I agree to notify FNB immediately if my login information becomes compromised.

I understand that if I change my e-mail address, I must notify FNB in writing. I may change my e-mail address or revoke this request to receive electronic statement(s) by written notice to First National Bank in Pinckneyville, Attn: Bookkeeping, PO Box 208, Pinckneyville, IL 62274-0208.

I understand that I may request, for a fee, a paper copy of my statement by contacting the FNB bookkeeping department.

* I (We) acknowledge and agree to the terms and conditions as outlined above.

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Products & Services

Electronic Statement Enrollment Application