Notice: E-mail is not a completely secure channel of communication. We ask that you limit your use of the e-mail form below to request general information about our customer services and products or general feedback about our website. We strongly suggest that you do not e-mail sensitive account information such as your Inland Bank Debit card number(s) or other account number(s), Social Security number, PIN, mother’s maiden name, or passwords.

Please answer the following questions when considering your preferences for a checking account.

 1. How did you hear about Inland Bank?

 2. What type of business do you have?

 3. Location of business:

 4. Do you own, lease or work from a home office?

 5. Number of employees:

 6. Is your business a: Select one Corporation Partnership LLC Sole Proprietor Not for profit

 7. What features interest you?

     Free no minimum balance

     An account that earns interest

     Premium interest for higher balances

 8. What balances do you anticipate? Select one Less than $1,000 $1,000-$5,000 $5,000-$10,000 $10,000+

 9. What type of services do you currently use or would like to know more about?

10. Who do you consider your primary bank?

11. How would you rank your customer service experience with your current primary bank? 
      (Dislike-1; Extermely Like-10)   Select one 1 2 3 4 5 6 7 8 9 10

12. What can we do to make your banking experience a 10?

13. Comments:

By providing contact information, you can expect a call from an Inland Bank personal banker by end of next business day.

Name

How would you like to be contacted? Select one Phone Email

Contact Number Email Address:

Your Preference for a return call time (a.m./p.m.): Select one a.m. p.m

What Branch is most convenient? Select one Countryside Elmhurst Glen Ellyn Glen Ellyn Drive-Thru Hawthorn Woods Hillside Lake Zurich Lombard Morton Grove Villa Park

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Please Note: Do not include any confidential information on this form.