TrustTexas Bank - E-STATEMENT ENROLLMENT FORM

E-STATEMENT ENROLLMENT FORM

Submitter Information

First Name (required)

Last Name (required)

Resolve the errors marked in red before submitting again.

	Customer Information
First Name	(required)
Last Name	(required)
Business Name
Social Security or Tax ID Number	(required)
Home Phone Number	(required)
Email	(required)

Address

Street Address Line 1

Street Address Line 2

City

State

ZIP Code

Activate the following accounts for E-statements:

	Account Numbers
Checking Account Number(s)
Savings Account Number(s)

	Yes, I agree to the Terms and Conditions explained in the TrustTexas Bank, SSB eStatements Disclosure.
	(required)

	PDF Code
PDF Code	(required)

	Signature	Date
	(required)	(required)

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