Check Copies Request

To request copies of your cancelled checks, please fill out this form and submit it to Bluestem (This is a secure form).
Alternatively, the page can be printed and mailed to Bluestem Bank, 104 East Locust, Fairbury, IL 61739.

Name:
Address:
City, State Zip: ,
Phone: Home: Business:
Checking Account Number


Date of Check Check Number Amount of Check Payable To

Additional Comments or Instructions:


Upon receipt of this Check Copy Request our Customer Service Department will research the requested check(s) and mail you copies of both front and back of each check requested. Bluestem Bank will charge a check copy fee based on the fee schedule you have already received. Please allow up to 5 business days for delivery of your check copies.