Union State Bank

Opt out Notice
Please complete this form to remove yourself from having any information shared to affiliates, non-affiliated third parties and to remove yourself from mailing lists the bank provides.

By completing this form, you will remove yourself and any other person who has joint accounts with you from the various mailing lists. If that person also has accounts in their name alone and joint with another person, they will continue to be listed on our marketing lists until they also complete this form. If you are the parent of a minor, we will also remove the minor child’s name from any marketing lists.

Affiliates of Union State Bank:

    • Novak Agency, Inc. - A wholly owned subsidiary of the Union State Bank that provides a range of financial services from insurance coverage through investment products. They also have a real estate division.
    • Kewaunee Investments, Inc. – A wholly owned subsidiary of the Union State Bank that provides investment services to the bank only. This company’s only customer is the Union State Bank.

Please select your option below:
   
  Please remove my name from all marketing lists, including Union State Bank, affiliates and non-affiliated third parties. I understand that I will continue to receive some mailings from the Union State Bank including my account statements and any other regulatory mailings.
   
  Please remove my name from the non-affiliated mailing list. I understand the Union State Bank and affiliates can send me information on their products and services.
   
  Please remove my name from the non-affiliated and affiliates mailing list. I understand that Union State Bank can send me information on their products and services.
 
   
Please print your name here  
   
   
Please sign your name here  
   
   
Social Security Number  
   

Upon completion of the form, please fax it to 920-388-3487 or mail it to:

 

Union State Bank
PO Box 337

Kewaunee, WI 54216

PLEASE DO NOT E-MAIL THIS FORM.