FREESTAR Bank

Electronic Document Delivery Service
Enrollment Form
(Requires Freestar Online Banking Account)

* = Required Field

Please fill out this secure form
First Name:*
Middle Initial:
Last Name:*
Mailing Address:*
City:*
State:*
Zip:*
Home Phone:*
Business Phone:

Designated Account Number(s) for this service:†	Account Type
*





† You must be an owner of each account

Designated E-Mail Address for Delivery:*
Verify E-Mail Address:*

Read the E-Statements Agreement
I have read and agree to the terms and conditions of the E-Statements Agreement.



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