e-Statement Enrollment Form

Required fields are bold and marked with an asterisk (*).

Primary Account Holder
First Name: *		Last Name: *
Address: *
Address line 2:
City: *		State: *		ZIP: *
Daytime Phone: *	ex. 555-555-1212	Cell Phone:	ex. 555-555-1212
E-mail Address: *	ex. someone@yahoo.com
PAC FCU Account # *
Additional Account #
Additional Account #

Terms and Disclosures:

No paper statements will be issued for your account. Statements will be accessible via electronic means.
A $10 fee will be assessed every time a paper statement will be requested.
The $2.00 monthly share draft/checking account maintenance fee will be waived for as long as you continue to be enrolled in e-Statements. Cancellation of your e-Statement enrollment will automatically re-institute the $2.00 monthly share draft/checking account maintenance fee.

Preview e-Statements - You must verify you are able to view PDF files

Before you can sign up for e-Statements, you need to preview an e-Statement and acknowledge that you can view it successfully. Adobe Reader is required to view the e-Statement in its PDF format. If you do not have Adobe Reader installed, please click on the 'Get ADOBE READER' download image below. After you have verified that you have Adobe Reader, please click on the Preview e-Statement link to proceed.

If you are able to successfully view the e-Statement, please check the box that states you viewed the e-Statement successfully and click Submit. If you are unable to view the e-Statement, please contact us.

e-Statements require Adobe Reader
Click the image below to install Adobe Reader.

e-Signature & e-Statement Preview Verification
Name: *	Repeat from above. This will act as your e-Signature.
	I agree that the information submitted on this form is true and I have read the above terms and disclosures and agree to them.
	Viewed e-Statement Successfully