Business Services Request Form

Business Information

Contact Person Information

Business Services Request

Business eStatements Disclosure

Choosing "Free Business eStatements" above and submitting this form gives National Exchange Bank & Trust your affirmative consent and agreement to the following terms:

• All your deposit account statements, related notices and required disclosures, if available, will be delivered electronically.
• You will provide your business' current e-mail contact information and agree to keep your e-mail address updated in our files to ensure that it is current.
• You are able to view the PDF file in which the statement is provided.
• National Exchange Bank & Trust eStatements are provided at no charge to our customers. Access to eStatements requires that paper statements be discontinued.
• To withdraw your consent to receive National Exchange Bank & Trust eStatements and disclosures electronically, please call
  877-495-6989. Withdrawal of consent requires that you receive your statements and disclosures via the U.S. Postal Service. Written notification may be required.
• A username and password are required to retrieve your eStatement. Your username will be e-mailed to the e-mail address you provided to us on this form. Your password will be communicated to you via the telephone.

Please print this page for your records before clicking "Submit."