Statement Delivery Change Request Form

In an effort to protect our environment, streamline processes and reduce costs First Capital Bank of Kentucky has decided to begin charging a $3.00 per paper statement fee as of September 1, 2014.  As an alternative to paper statements we have provided you with the option of electronic statements.  Avoid the fees and sign up for electronic statements below.

 

Personal Identification
Full Name: 
Last Four Digits of Tax ID: 
Date of Birth: 
Street Address: 
City: 
State: 
Zip: 
Email Address for Notifications: 
Verify Email Address: 
Account Selection
Apply the delivery option selected below to all of my accounts.
Apply the delivery option selected below only to specific accounts listed below. The statement delivery method for the remainder of my accounts will remain the same.
 
Delivery Options
I would like to receive paper statements at $3.00 per statement, per month. First Capital Plus checking accounts will continue to receive paper statements free of charge. Contact your branch manager for more details.
I am a registered Online Banking user and would like for my statements to be delivered to my Online Banking portal.
  Please enter your Online Banking Access ID:
    I agree to the Terms and Conditions of the Electronic Delivery of Statements Consent and Agreement policy.
I am not a registered Online Banking user and would like for my statements to be delivered via secure email to CSIeSafe.com.
  • You will retrieve your statements from CSIeSafe.com
• You will receive login instructions and credentials to the email listed above once your account is setup.
    I agree to the Terms and Conditions of the Electronic Delivery of Statements Consent and Agreement policy.