Enroll in Electronic Statements

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Company Tax ID Number

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Company Name

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Physical Address

Address 2

Zip

City

State

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Full Account Number

Type

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Full Account Number

Type

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Full Account Number

Type

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Full Account Number

Type

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Email

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Disclosure Acceptance Verification
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- Please_indicate_your_agreement_belowPlease indicate your agreement below: Yes, I understand that by clicking the Submit button below I am agreeing that I will no longer receive a paper copy of my bank statement or account notice, rather an e-mail indicating that my statement or notice is ready for viewing in OCM. I also agree to receive other documents, notices, etc., electronically as they become available in the future. Furthermore, I acknowledge that I understand that all authorized users with access to inquire on these accounts in OCM will be able to retrieve electronic documents and I agree to promptly notify MidWestOne Bank if my e-mail address changes. No, I do not agree.
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Name

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Date

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Disclosure Acceptance Verification