eStatement Authorization

Please fill out the fields in the form below. One of our representatives will contact you within one business day to complete the process. Completion of the account opening must be done within 10 days at a local branch as a copy of your ID and a signature is required. If no action is taken within 10 days, the account will be closed. 

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  • OK Name is required
  • OK Account Number is required

  • I/We the undersigned, authorize Belgrade State Bank to e-mail information regarding the above listed account(s) to me/us upon my/our request. I/We understand that information will only be e-mailed to the address(es) below, and that I/we will inform the bank should these addresses change by completing a "Change-of-Address" form and re- authenticating each address given. I/We understand that it is my/our responsibility to keep any passwords and/or account information private and not store or send the information where it can be accessed by others. I/Weunderstand that I/we may use up to three (3) e-mail addresses. *Please be aware that this is case sensitive.*

  • OK Email Address is required
  • Optional OK Email Address is required
  • Optional OK Email Address is required

  • Click here to read E Sign Act Disclosure

    OK I have read the E Sign Disclosure Agreement is required

    • Security Code

  • OK is required