Bank Statement Request Form
A statement is easier to file when the period and the file arrive together. This bank statement request form asks for the client, the bank name, a nickname or the last four digits, the statement period, how they will send the file, and notes. It never asks for a full account number, a routing number, a password, or a card number. Edit the send choices, try it, then send one link per statement.
Last reviewed November 9, 2026 by FormSign team.
Edit it, try it, then create an account to save and share.
Build for free. Pay once a workflow goes live at 10 submissions or 2 documents sent for signature.
Questions in this template
Client
- Client or business name (required)
- Email (required)
The account
- Bank name (required)
- Account nickname or last four (required)A nickname or the last four digits only.
The statement
- Period start (required)
- Period end (required)
- How to send (required)Upload here · Already emailed
- StatementOptional if you already emailed the file.
- Notes
What is a bank statement request form?
A bank statement request form is the note you send when you need one statement: which bank, which period, and where the file is. The full account number stays off the form.
When to use it
- When a client still owes a statement for a month.
- When you want the period written next to the file.
- When the file might already be in your email and you only need that noted.
- When several clients should answer the same questions.
What to include
Who it is for
Client or business name, and an email.
Which account, safely
Bank name, plus a nickname or the last four digits only.
The period and the file
Start and end dates, how they will send it, the file, and notes.
What to leave out
Do not ask for a full account number, a routing number, a password, or a card number.
Why FormSign
Each statement request becomes a row on your FormSign board, with the file on that row when they upload it. The starter letter uses each question's label as a placeholder, so a follow-up note matches the form.
This template is a starting point, not legal advice. Ask for the statement file. Do not collect a full account number, a routing number, a password, or a card number.
Questions
Should the client type the full account number?
No. Ask for a nickname or the last four digits only. The statement file carries the rest.
What if they already emailed the statement?
They can choose already emailed and leave the upload empty. Use notes if the file name would help.
Can they upload the file on this form?
Yes. Choose upload here and attach the statement. A PDF is fine.
Should I add a routing number, a password, or a card number?
No. This template does not collect those. Leave them out if you edit the form.
Do I need an account to try it?
No. Open the template and test an upload. You'll create an account when you want to save it and send it.
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Start with this template
Build for free. Pay once a workflow goes live at 10 submissions or 2 documents sent for signature.