Business Account Setup Form

Business Account Setup and Services Agreement

Parties and Recitals

This Agreement is entered into between Applicant Business Name: (the "Applicant") and Service Provider Name: (the "Provider").

WHEREAS, the Applicant desires to establish one or more business accounts and obtain related services from the Provider; and

WHEREAS, the Provider is willing to open, maintain and provide such accounts and ancillary services on the terms set forth in this Agreement; and

WHEREAS, the parties intend that this Agreement set forth the full terms of their relationship with respect to the accounts and services described below.

Business Information

LLC Corporation Partnership Sole Proprietor Other:

Ownership and Authorized Signers

Provide all owners with 25% or greater ownership and the individuals authorized to transact on the account.

Services Requested

Select all account types and services requested:

Operating/Checking Account Savings Account Merchant Services ACH Origination

Wire Transfer Online Banking Credit Line / Overdraft Facility Other:

Scope of Work

Describe the services to be provided by the Provider in connection with the accounts, including any implementation, integration, transaction processing, or ancillary services.

Payment Terms

Fees for services, maintenance, and any one-time implementation charges are payable as set forth below.

All amounts payable under this Agreement are non-refundable except as expressly stated in writing. The Applicant shall be responsible for taxes levied on services provided under this Agreement unless a valid exemption is furnished.

Term and Termination

This Agreement commences on the Effective Date and continues until terminated in accordance with this Section.

Effective Date:     Term End Date:

Either party may terminate this Agreement for convenience upon written notice to the other party delivered not less than days prior to the effective termination date. Termination for material breach by either party shall be effective upon written notice if the breach is not cured within thirty (30) days after receipt of notice of the breach.

Confidentiality

Each party shall hold in strict confidence all Confidential Information disclosed by the other party and shall not disclose Confidential Information to any third party except as required by law or as necessary to perform its obligations under this Agreement. "Confidential Information" means non-public information disclosed in any form that is marked confidential or that a reasonable person would understand to be confidential given the nature of the information and the circumstances of disclosure.

This obligation does not apply to information that (a) is or becomes generally available to the public other than by breach of this Agreement; (b) was lawfully in the receiving party's possession prior to disclosure; or (c) is independently developed without use of the disclosing party's Confidential Information.

Compliance and Certifications

By signing this Agreement, the Applicant certifies that all information provided is true, complete and accurate to the best of its knowledge; that the Applicant is authorized to execute this Agreement; and that the Applicant will provide upon request valid documentary evidence to support any information provided herein.

Applicant certifies that the beneficial owner and identification information required by law has been provided.

Applicant represents that it is not subject to any sanction or prohibition that would prevent the Provider from opening or maintaining the requested accounts.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of: without regard to its conflict of law principles. The parties submit to the exclusive jurisdiction of the state and federal courts located in that state for any dispute arising out of or relating to this Agreement.

Entire Agreement

This Agreement, together with any exhibits, schedules and account opening documents executed by the parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals and communications, whether oral or written. No amendment or modification of this Agreement will be effective unless in writing and signed by both parties.

Supporting Documents Checklist

Please indicate the documents provided with this application:

Articles of Organization / Incorporation EIN Confirmation Letter

Photo ID for beneficial owners Corporate Resolution / Authorization

Representations and Warranties

The Applicant represents and warrants that it is duly organized and in good standing under applicable law, that the person signing on behalf of the Applicant is duly authorized to do so, and that the Applicant will comply with all applicable laws and regulations in connection with the account and services.

Acceptance and Execution

By executing below, the parties acknowledge that they have read, understand and agree to be bound by the terms and conditions of this Agreement and that the information provided in this form is true and correct.

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