ATHENA CREDIT UNION

E-Statement Disclosure and Consent Form

By signing below, you agree to accept your periodic account statement(s) online. Your E-Statement will include the periodic account(s), transaction activity for your deposit(s), and loan accounts.

Please return or mail a signed copy of this form to Athena Credit Union, 1427 W. First Street , Springfield , OH 45504 .

You have the right to request and receive periodic statements in paper form and you may withdraw your consent to receive online statements by giving your instructions at any time by contacting the credit union.

You will be able to retrieve your online statement by browsing to the designated URL/web address as provided by the credit union. After logging onto a secure website you will have the ability to view your statement online. See below for minimum hardware and software requirements.

There are no fees for E-Statement online.

In order to receive your statement for the current month, you must enroll by the 25th of the month.

Minimum Hardware:

You must have a computer capable of establishing an internet connection. Speed of the computer and internet connection may affect performance of the E-Statement service.

Minimum Software:

Computer must have an Internet Explorer or Netscape versions 4.0 or higher with 128bit encryption.

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Member Signature  Date
Account Number          ____________________  
Account Number          ____________________  
Account Number          ____________________  
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Credit Union Employee Date