Bank Client Information Form

Bank Client Information and Services Agreement

Bank Name:     Client Name:

Whereas

WHEREAS, Bank Name is authorized to provide banking, depositary, payments, and related financial services to business and individual clients under applicable law and internal policies; and

WHEREAS, Client wishes to establish a client relationship with Bank for the purpose of opening accounts and receiving services described herein, provided that Client furnishes accurate identifying information and complies with Bank policies; and

NOW, THEREFORE, in consideration of the mutual covenants set forth below, the parties agree as follows.

Client Information

Individual   Corporation   Partnership   Trust   Other

Phone   Email   Mail   Secure messaging / online portal

Account Services Requested

Checking account   Savings account   Business checking   Merchant services

Wire transfer capability   ACH origination/receipt   Online banking / bill pay   Loan or credit facility

Scope of Work

The Bank will provide the services selected above and such other services as agreed in writing. The specific duties include receipt and maintenance of deposits, processing of payment instructions, administration of authorized signatories, providing periodic statements, and any ancillary services described in the service schedule below.

Payment Terms

Client agrees to pay fees for services in accordance with the Fee Schedule. Unless otherwise agreed in writing, Client shall pay a recurring service fee of $ per .

Payment schedule:

Late payment: overdue amounts shall accrue interest at or a flat late fee of $ , whichever is greater, as permitted by law.

Term and Termination

Term Commencement Date: .

Initial Term Expiration Date: .

Either party may terminate this Agreement without cause upon written notice provided at least days prior to the effective date of termination. Termination for material breach may be immediate where permitted by law.

Confidentiality

Each party shall maintain the confidentiality of non-public information disclosed by the other party in connection with this Agreement. Confidential information shall not include information that is public through no fault of the receiving party, independently developed, or required to be disclosed by law. The receiving party shall use at least the same degree of care to protect Confidential Information as it uses for its own confidential information, but in no event less than reasonable care.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflicts of law rules.

Entire Agreement

This Agreement, including any schedules, attachments, and account forms executed in connection herewith, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior and contemporaneous agreements, understandings, negotiations, and discussions, whether oral or written.

Certifications and Representations

Client certifies under penalty of perjury that all information provided on this form is true, correct, and complete to the best of Client's knowledge. Client further represents that it will provide updated information promptly if any material change occurs.

Client certifies accuracy of information   Client acknowledges Bank's anti-money laundering policies and agrees to cooperate with identification and verification requirements

Compliance and Notices

Client agrees to provide, upon request, documents required for beneficial ownership verification and any other information necessary for the Bank to comply with applicable laws and internal policies. Notices under this Agreement shall be effective when delivered in writing to the addresses listed above, or to any updated address provided in writing.

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