Bank of Belleville     


Online Statement Enrollment Form


 Receive Your Bank Statement Sooner! Receive Your Statement Online!




You must first be a customer of NetTeller Online Banking to receive your monthly statements online.  If you do not already

have an online banking account, you may enroll on this website now.   To enroll for e-Statements, just print and complete

the enrollment form then mail or deliver to Bank of Belleville, 720 West Main Street, Belleville, IL  62220.


That’s right!  You can receive your monthly bank statements online through NetTeller online banking.   Open our website and

sign in on the convenient link on the first page.   No waiting for the mail to arrive… balancing your statement will be easier

than ever!  You’ll be able to save your monthly statement files to your computer and store them securely as long as you would

like to have access to them.  You’ll have your statement history at your fingertips with the click of a mouse!  You’ll be going

 “green” and helping the environment!


Receiving your statements online is an optional free service provided by Bank of Belleville.  If you select this service, you

authorize Bank of Belleville to provide an electronic monthly statement, and any other additional correspondence that may

be required involving the status of any account(s) for which you are the primary account holder.  Additionally, you authorize

Bank of Belleville to provide an electronic Privacy Notice in the mail.  In the future, Bank of Belleville may provide

other correspondence regarding these account(s) in electronic format only.


Each and every month on your statement cycle date, Bank of Belleville will send you an email notifying you that your statement

is available for viewing through your online account at


You have the ability to retain a copy of your electronic statement and Privacy Notice by printing.  You also have the ability to

save a copy of your statement to your hard drive, a CD, flash drive, etc.  Your electronic statement will be available for

viewing or downloading for up to one year after the statement cycle date.  It is your responsibility to notify Bank of Belleville

of any changes to your email address.


By submitting this form, you understand that you are obligated to review your statement for errors and omissions.  Please

refer to your account disclosures for specific rules and regulations regarding your obligations.  (Account disclosures are

available upon request.)   To request a free paper copy statement, switch from electronic statement to paper statements,

or update your email address, contact Bank of Belleville, 720 West Main Street, Belleville, IL  62220 or call 618 233-6400. 

You may also email us at   Any withdrawal of your consent to receive electronic communications

will be effective only after we have a reasonable period of time to process your withdrawal.  Once you have requested

online statements, you may still receive one more printed statement as we complete your request. 


We reserve the right, at our discretion, to discontinue the provision of your electronic communications, or to terminate or

change the terms and conditions on which we provide electronic communications.  We will provide you with notice of any

such termination or change as required by law.

Name:   ____________________________________________     Phone:   ______________________________


Current email address:   _______________________________________________________________________


Mailing address:   _____________________________________________________________________________


Authorized Signature:    ___________________________________________________    Date:   ____________