{"id":60,"date":"2025-01-29T21:28:14","date_gmt":"2025-01-29T21:28:14","guid":{"rendered":"https:\/\/www.fcbok.com\/?page_id=60"},"modified":"2025-01-29T21:28:21","modified_gmt":"2025-01-29T21:28:21","slug":"statement-delivery-change-request-form","status":"publish","type":"page","link":"https:\/\/www.fcbok.com\/form-statement-delivery.htm","title":{"rendered":"Statement Delivery Change Request Form"},"content":{"rendered":"\n<div class=\"int\">\n<div id=\"leftcol\">\n\n\n  <div id=\"onlineBanking-new\">\n  \n  <div class=\"new-rates\">\n  \n  \n  \n  \n  \n  <p>\n  Mortgage Rates <span>| <a href=\"\/personal-mortgage-products-rates.htm\">Learn More \u2771<\/a><\/span>\n  <\/p>\n  <table>\n  <tbody><tr>\n  <td>15YR<\/td>\n  <td>\u25e3<\/td>\n  <td>3.125%<\/td>\n  <td>\u25b8<\/td>\n  <td style=\"font-weight: normal;font-style: italic;\">3.148% APR<\/td>\n  <\/tr>\n  <tr>\n  <td>30YR<\/td>\n  <td>\u25e3<\/td>\n  <td>3.750%<\/td>\n  <td>\u25b8<\/td>\n  <td style=\"font-weight: normal;font-style: italic;\">3.763% APR<\/td>\n  <\/tr>\n  <\/tbody><\/table>\n   \n  <\/div><!-- end rates -->\n  \n  <div style=\"clear: both; height: 1px;background: transparent;\"><\/div>\n  \n  <\/div> <!-- end #onlineBanking-new -->\n   \n  \n  <div class=\"leftnav\">\n  <ul>\n  \n  \n  \n     \n            <li><a href=\"\/locations.htm\">\n              Locations\n            <\/a>\n         \n       <ul>\n     \n            <li><a href=\"\/locations-fern-creek.htm\">\n              Branch &#8211; Fern Creek\n            <\/a><\/li>\n        \n     \n            <li><a href=\"\/locations-cresecent-hill.htm\">\n              Branch &#8211; Crescent Hill\n            <\/a><\/li>\n        \n     \n            <li><a href=\"\/locations-jeffersontown.htm\">\n              Branch &#8211; Jeffersontown\n            <\/a><\/li>\n        \n     \n     \n            <li><a href=\"\/locations-st-mathews.htm\">\n              Branch &#8211; St. Matthews\n            <\/a><\/li>\n        \n     \n            <li><a href=\"\/locations-strathmoor.htm\">\n              Branch &#8211; Strathmoor\n            <\/a><\/li>\n        \n     \n        <\/ul>\n  <\/li>\n      \n  \n     \n            <li><a href=\"\/support.htm\">\n              Support\n            <\/a><\/li>\n        \n     \n            <li><a href=\"\/resources-check-reorder.htm\">\n              Check Reorder\n            <\/a><\/li>\n        \n     \n            <li><a href=\"\/financial-calculators.htm\">\n              Financial Calculators\n            <\/a><\/li>\n        \n     \n            <li><a href=\"\/resources-business-continuity-plan.htm\">\n              Business Continuity Plan\n            <\/a><\/li>\n        \n     \n            <li><a href=\"\/privacy.htm\">\n              Privacy Policy\n            <\/a><\/li>\n        \n     \n            <li><a href=\"\/terms.htm\">\n              Terms of Use\n            <\/a><\/li>\n        \n  \n            <li class=\"active\"><a href=\"\/form-statement-delivery.htm\">\n              Statement Delivery Options\n            <\/a><\/li>\n        \n   \n  \n  <\/ul>\n  <\/div><!-- end .leftnav -->\n  \n  <\/div>\n\n<div id=\"rightcol\">\n  <div id=\"content\" style=\"background: #FFF url();\">\n  \n  \n   \n  <table cellspacing=\"0\" cellpadding=\"10\" border=\"0\" style=\" width: 100%;\">\n        <tbody><tr>\n          <td style=\" height: 30px; background-color: #ac8d50;\">\n            <h1><span style=\" font-size: 24px;\"><span style=\" color: #ffffff;\"><strong>Statement Delivery Change Request Form<\/strong><\/span><\/span> <\/h1>\n          <\/td>\n        <\/tr>\n        <tr>\n          <td style=\" text-align: justify; vertical-align: middle; width: 100%;\">\n            <span style=\" color: #1d7210;\"><span style=\" font-size: 14px;\">In an effort to protect our environment, streamline processes and reduce costs First Capital Bank of Kentucky has decided to begin charging a $3.00 per paper statement fee as of September 1, 2014. &nbsp;As an alternative to paper statements we have provided you with the option of electronic statements. &nbsp;Avoid the fees and sign up for electronic statements below.<\/span><\/span> \n          <\/td>\n        <\/tr>\n      <\/tbody><\/table>\n      <p>\n         &nbsp;\n      <\/p>\n   <div id=\"contact-form\">\n  <form name=\"StatementDelivery\" id=\"StatementDelivery\" action=\"\/siteplugins\/premiumpluscontrols\/FormProcess.aspx\" method=\"post\" autocomplete=\"off\" class=\"form\">\n  <input type=\"hidden\" value=\"1a5212c8-8907-e411-8540-005056b50015\" name=\"ds_formID\"> \n        <table cellspacing=\"0\" cellpadding=\"5\" width=\"90%\" align=\"center\" border=\"0\">\n          <tbody>\n          <tr>\n            <td colspan=\"2\" bgcolor=\"#E8E8E8\" class=\"tableTop\">\n              Personal Identification<\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" align=\"right\">\n              Full Name:&nbsp;\n            <\/td>\n            <td align=\"left\" class=\"tableBottom\">\n              <input size=\"40\" name=\"FullName\" id=\"FullName\" type=\"text\">\n            <\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" nowrap=\"nowrap\" align=\"right\">\n             Last Four Digits of Tax ID:&nbsp;\n            <\/td>\n            <td align=\"left\" class=\"tableBottom\">\n              <input size=\"40\" name=\"Last4DigitsTaxID\" id=\"Last4DigitsTaxID\" type=\"text\">\n            <\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" align=\"right\">\n              Date of Birth:&nbsp;\n            <\/td>\n            <td align=\"left\" class=\"tableBottom\">\n              <input size=\"40\" name=\"DOB\" id=\"DOB\" type=\"text\">\n            <\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" align=\"right\">Street Address:&nbsp;<\/td>\n            <td align=\"left\" class=\"tableBottom\"><input size=\"40\" name=\"Street\" id=\"Street\" type=\"text\"><\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" align=\"right\">\n              City:&nbsp;\n            <\/td>\n            <td align=\"left\" class=\"tableBottom\">\n              <input size=\"40\" name=\"City\" id=\"City\" type=\"text\">\n            <\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" align=\"right\">\n              State:&nbsp;\n            <\/td>\n            <td align=\"left\" class=\"tableBottom\">\n  <select name=\"State\" id=\"State\">\n              <option value=\"AL\">Alabama<\/option>\n  <option value=\"AK\">Alaska<\/option>\n  <option value=\"AZ\">Arizona<\/option>\n  <option value=\"AR\">Arkansas<\/option>    \n  <option value=\"CA\">California<\/option>    \n  <option value=\"CO\">Colorado<\/option>    \n  <option value=\"CT\">Connecticut<\/option>    \n  <option value=\"DE\">Delaware<\/option>    \n  <option value=\"DC\">District Of Columbia<\/option>    \n  <option value=\"FL\">Florida<\/option>    \n  <option value=\"GA\">Georgia<\/option>    \n  <option value=\"HI\">Hawaii<\/option>    \n  <option value=\"ID\">Idaho<\/option>    \n  <option value=\"IL\">Illinois<\/option>    \n  <option value=\"IN\">Indiana<\/option>    \n  <option value=\"IA\">Iowa<\/option>    \n  <option value=\"KS\">Kansas<\/option>    \n  <option value=\"KY\" selected=\"selected\">Kentucky<\/option>    \n  <option value=\"LA\">Louisiana<\/option>    \n  <option value=\"ME\">Maine<\/option>\n  <option value=\"MD\">Maryland<\/option>\n  <option value=\"MA\">Massachusetts<\/option>\n  <option value=\"MI\">Michigan<\/option>\n  <option value=\"MN\">Minnesota<\/option>\n  <option value=\"MS\">Mississippi<\/option>\n  <option value=\"MO\">Missouri<\/option>\n  <option value=\"MT\">Montana<\/option>\n  <option value=\"NE\">Nebraska<\/option>    \n  <option value=\"NV\">Nevada<\/option>    \n  <option value=\"NH\">New Hampshire<\/option>    \n  <option value=\"NJ\">New Jersey<\/option>    \n  <option value=\"NM\">New Mexico<\/option>\n  <option value=\"NY\">New York<\/option>    \n  <option value=\"NC\">North Carolina<\/option>\n  <option value=\"ND\">North Dakota<\/option>\n  <option value=\"OH\">Ohio<\/option>    \n  <option value=\"OK\">Oklahoma<\/option>\n  <option value=\"OR\">Oregon<\/option>\n  <option value=\"PA\">Pennsylvania<\/option>\n  <option value=\"RI\">Rhode Island<\/option>\n  <option value=\"SC\">South Carolina<\/option>\n  <option value=\"SD\">South Dakota<\/option>\n  <option value=\"TN\">Tennessee<\/option>\n  <option value=\"TX\">Texas<\/option>\n  <option value=\"UT\">Utah<\/option>\n  <option value=\"VT\">Vermont<\/option>    \n  <option value=\"VA\">Virginia<\/option>\n  <option value=\"WA\">Washington<\/option>    \n  <option value=\"WV\">West Virginia<\/option>    \n  <option value=\"WI\">Wisconsin<\/option>\n  <option value=\"WY\">Wyoming<\/option> \n  <\/select>\n           <\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" align=\"right\">\n              Zip:&nbsp;\n            <\/td>\n            <td align=\"left\" class=\"tableBottom\">\n              <input name=\"Zip\" id=\"Zip\" type=\"text\" size=\"5\" maxlength=\"5\">\n            <\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" align=\"right\">\n              Email Address for Notifications:&nbsp;          <\/td>\n            <td align=\"left\" class=\"tableBottom\"><input value=\"\" class=\"validate[required,custom[email]] text-input\" type=\"text\" name=\"email1\" id=\"email1\">\n            <\/td>        <\/tr>\n          <tr>\n            <td class=\"tableBottom\" align=\"right\">\n              Verify Email Address:&nbsp;\n            <\/td>\n            <td align=\"left\" class=\"tableBottom\">\n              <input value=\"\" class=\"validate[required,equals[email1]] text-input\" type=\"text\" name=\"Email2\" id=\"Email2\">\n            <\/td>        <\/tr>\n          <tr>\n            <td colspan=\"2\" nowrap=\"nowrap\" bgcolor=\"#E8E8E8\" class=\"tableBottom\">Account Selection<\/td>\n            <\/tr>\n          <tr>\n            <td align=\"right\" valign=\"top\" class=\"tableBottom\"><input name=\"ApplyDeliveryOption\" type=\"checkbox\" style=\"min-width:12px;width:12px;border:none;\" id=\"ApplyDeliveryOption\" value=\"ToAllAccounts\"><\/td>\n            <td valign=\"top\" class=\"tableBottom\"> Apply the delivery option selected below to all of my accounts.<\/td>\n            <\/tr>\n          <tr>\n            <td align=\"right\" valign=\"top\" class=\"tableBottom\"><input name=\"ApplyDeliveryOption\" type=\"checkbox\" style=\"min-width:12px;width:12px;border:none;\" id=\"ApplyDeliveryOption\" value=\"ToSelectedAccounts\"><\/td>\n            <td valign=\"top\" class=\"tableBottom\">Apply the delivery option selected below only to specific accounts listed below. The statement delivery method for the remainder of my accounts will remain the same.<\/td>\n          <\/tr>\n          <tr>\n            <td align=\"right\" valign=\"top\" class=\"tableBottom\">&nbsp;<\/td>\n            <td valign=\"top\" class=\"tableBottom\"><textarea name=\"DeliveryOptionAccountList\" cols=\"40\" id=\"DeliveryOptionAccountList\">Please list applicable accounts separated by commas:\n            <\/textarea><\/td>\n          <\/tr>\n          <tr>\n            <td colspan=\"2\" valign=\"top\" bgcolor=\"#E8E8E8\" class=\"tableBottom\">Delivery Options<\/td>\n            <\/tr>\n          <tr>\n            <td class=\"tableBottom\" valign=\"top\" align=\"right\"><input name=\"ReceivePaperStmts\" type=\"checkbox\" style=\"min-width:12px;width:12px;border:none;\" id=\"ReceivePaperStmts\" value=\"Yes\"><\/td>\n            <td align=\"left\" class=\"tableBottom\">I would like to receive paper statements at $3.00 per statement, per month.  First Capital Plus checking accounts will continue to receive paper statements free of charge.  Contact your branch manager for more details.<\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" valign=\"top\" align=\"right\"><input name=\"RegisteredStmtsOnline\" type=\"checkbox\" style=\"min-width:12px;width:12px;border:none;\" id=\"RegisteredStmtsOnline\" value=\"Yes\"><\/td>\n            <td align=\"left\" class=\"tableBottom\">I am a registered Online Banking user and would like for my statements to be delivered to my Online Banking portal.<\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" valign=\"top\" align=\"right\">&nbsp;<\/td>\n            <td align=\"left\" class=\"tableBottom\">Please enter your Online Banking Access ID:\n            <input size=\"40\" name=\"OnlineID\" id=\"OnlineID\" type=\"text\"><\/td>\n            <\/tr>\n          <tr>\n            <td class=\"tableBottom\" valign=\"top\" align=\"right\">&nbsp;<\/td>\n            <td align=\"left\" bgcolor=\"#F2F2F2\" class=\"tableBottom\"><input name=\"RegisteredStmtsOnline\" type=\"checkbox\" style=\"min-width:12px;width:12px;float:left;padding-left:10px;border:none;\" id=\"RegisteredStmtsOnline\" value=\"AgreeToTerms\">&nbsp; I agree to the Terms and Conditions of the <a href=\"\/files\/Consent-Form-10July14.pdf\">Electronic Delivery of Statements Consent and Agreement<\/a> policy.<\/td>\n            <\/tr>\n          <tr>\n            <td class=\"tableBottom\" valign=\"top\" align=\"right\"><input name=\"NotRegisteredStmtsEmail\" type=\"checkbox\" style=\"min-width:12px;width:12px;border:none;\" id=\"NotRegisteredStmtsEmail\" value=\"Yes\"><\/td>\n            <td align=\"left\" class=\"tableBottom\">I am not a registered Online Banking user and would like for my statements to be delivered via secure email to CSIeSafe.com.<\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" valign=\"top\" align=\"right\">&nbsp;<\/td>\n            <td align=\"left\" class=\"tableBottom\">\u2022 You will retrieve your statements from CSIeSafe.com<br>\n            \u2022 You will receive login instructions and credentials to the email listed above once your account is setup. <\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" valign=\"top\" align=\"right\">&nbsp;<\/td>\n            <td align=\"left\" bgcolor=\"#F2F2F2\" class=\"tableBottom\"><input name=\"NotRegisteredStmtsEmail\" type=\"checkbox\" style=\"min-width:12px;width:12px;float:left;padding-left:10px;border:none;\" id=\"NotRegisteredStmtsEmail\" value=\"AgreeToTerms\">&nbsp; I agree to the Terms and Conditions of the <a href=\"\/files\/Consent-Form-10July14.pdf\">Electronic Delivery of Statements Consent and Agreement<\/a> policy.<\/td>\n          <\/tr>\n          <tr>\n            <td class=\"tableBottom\" valign=\"top\" align=\"right\">&nbsp;<\/td>\n            <td align=\"left\" class=\"tableBottom\">&nbsp;<\/td>\n          <\/tr>\n          <tr>\n            <td colspan=\"2\" align=\"center\" valign=\"top\" class=\"tableBottom\">\n              \n              <input type=\"\" name=\"btn_Submit\" class=\"button\" value=\"Submit\">\n            <\/td>\n            <\/tr>\n          <\/tbody>\n        <\/table>\n      <\/form>\n   <\/div>\n   \n  <\/div> <!-- end #content -->\n  <\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Mortgage Rates | Learn More \u2771 15YR \u25e3 3.125% \u25b8 3.148% APR 30YR \u25e3 3.750% \u25b8 3.763% APR Locations Branch &#8211; Fern Creek Branch &#8211; Crescent Hill Branch &#8211; Jeffersontown Branch &#8211; St. Matthews Branch &#8211; Strathmoor Support Check Reorder &hellip; <a href=\"https:\/\/www.fcbok.com\/form-statement-delivery.htm\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-60","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.3 - 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