electronic and paper forms

e-Statements Application

Electronic Statement Application

* Required

Account Information


Please list the accounts for which you would like to receive e-Statements (you may elect to receive an e-Statement for any account for which we provide a periodic statement.)


By clicking the submit button below, I/we request and consent to receive E-statements on the accounts listed above. I have received, read, and will comply with the Electronic Statement Agreement and Disclosure Statement as provided in its entirety. In summary, I understand that by enrolling:

  • I will receive my periodic statements, change in terms, notices, and any other disclosures electronically as an emailed attachment from Rayne State Bank for the accounts I have selected.
  • I will no longer receive paper statements in the mail for the accounts I have selected unless, after two attempts, the e-statement is deemed undeliverable; then paper statements will be mailed and appropriate fees charged until notified otherwise.
  • My E-statements will be generated on my normal statement cycle date.
  • I have been provided, and will comply, with the Bank's hardware and software requirements that are needed to access and retain my E-statements.
  • I will notify the Bank immediately of any change in my email address or complications relating to the electronic receipt or access of my E-statements.
  • I understand that the Electronic Statement Agreement and Disclosure in its entirely is located on the Bank's website, www.bankonnet.com, under the "Disclaimer/Privacy" tab.
  • I will be charged a $2.00 fee for each paper statement that is provided to me while I am enrolled in the Electronic Statement service.
  • At any time, I or any joint account holder can withdraw this consent by telephoning the Bank at (337) 334-3191 or (337) 235-2062, emailing the bookkeeping department at rsbtmt@bankonnet.com, or writing to the Bank at P.O. Box 129, Rayne, LA 70578. There will be no fee for canceling this service.

Thank you for your submission!

We will be in touch with you soon.