Online Loan E-Statement Enrollment Form

Please fill out the form below to enroll in E-Statements.  Please note that email notification for the accounts you list will be sent to the email address you supply.  If you have both personal and business accounts, it is recommended you submit a separate enrollment form.  

 

*required fields
First Name*:   Last Name*:  
Business Name:
(if applicable)
  Phone Number*:  
Email Address*:   Confirm Email Address*:  
Preferred Branch*:      
Loan Account #1*:   Loan Account #4:  
Loan Account #2:   Loan Account #5:  
Loan Account #3:   Loan Account #6:  
I wish to receive my loan statements and notifications via*:

Please read all information and accept the terms below to submit E-Statement enrollment form:

 

Consent and Authorization for Electronic Transmission of Account Statements

By completing this consent agreement, you agree to permit Reliant Bank ("Bank") to make disclosures and provide notices to you in electronic form, instead of providing such notices and disclosures in printed form.  

 

You have the right to receive a printed account statement sent to yourmailing address of record.  By entering into this agreement, you understand that the Bank will cease providing you with a printed statement in the mail, and that all future account statements will besent to the email address on record either as (1) a secured attachment accessible with a password or (2) maintained on Reliant Bank's online banking website where you may access to obtain, review, print and otherwise copy/download your periodic statement. If you choose to retrieve your statements/notifications via Reliant Bank’s online banking product, each statement cycle the Bank will send an email notifying you of the availability of your E-Statement.  You may then access your statement via a link to the Bank's website using the procedure the Bank authorizes.  You agree to notify the Bank immediately in writing of any change in your email address.  

 

You understand that if you decide in the future that you would like to receive a printed statement in the mail instead of receiving an electronic statement, you agree to notify the Bank in writing.  You may be required to sign a consent form regarding the requested change.  The Bank's telephone number and postal mail address are listed below in the section entitled "Communications Between the Bank and You".

 

Hardware and Software Requirements

We recommend Internet Explorer 5.0 of higher, but can support any browser with 128-bit encryption capabilities (i.e. Netscape 4.03 or higher).  To access, download, and print an E-Statement, you need to have a personal computer with Internet and email access.  You must also have Acrobat Reader 5.0 or higher.  To download a free copy or Adobe Acrobat Reader, please go to www.adobe.com

 

Communications Between the Bank and You

You can communicate with us in any of the following ways:

  • Telephone:  615-221-2020 or 1-877-221-2050
  • Facsimile:    615-221-2021
  • Postal Mail:  101 Creekstone Blvd., Suite 101, Franklin, TN 37064

 

Agreement:

By accepting these terms, you agree to receive an electronic statement in lieu of a paper statement and to provide a valid email address to the Bank so that email notification can be sent when the statement is available online.

 

"I hereby accept the terms and conditions as outlined in the above agreement and understand that by confirming, I am submitting my electronic consent."

 I Agree

Name of person agreeing to terms and conditions*: