Finance Account Opening Package

FINANCE ACCOUNT OPENING PACKAGE

Account Selection

Select account type(s) to open:

Checking Savings Brokerage Retirement / IRA Margin Trust / Custodial

Wire Transfer ACH Debit Check Transfer from Existing Account

Applicant Information

Individual Entity / Organization

Date of formation / Date of birth:     Taxpayer ID (SSN or EIN):

Type:    Number:    Issuing State/Country:

Tax and Regulatory Classification

By checking the applicable box you certify your U.S. tax status and FATCA classification.

US Person (citizen or resident) Foreign Person

Beneficial Owner(s) — Required for Entities

Provide legal name and ownership interest for each individual who directly or indirectly owns 25% or more of the equity, or who controls the entity.

Date of birth:    SSN/TIN:    Ownership %:

Date of birth:    SSN/TIN:    Ownership %:

Authorized Signatory / Account Access

List persons authorized to transact on the account (if different from applicant). Provide name, title, and authority limits.

Source of Funds and Purpose

Compliance, Certifications and Acknowledgements

I certify that the information provided in this Account Opening Package is true, correct and complete to the best of my knowledge. I understand that the financial institution will rely on this information to open and maintain the account and that providing false or misleading information may subject me to civil or criminal penalties.

I authorize the institution to verify any information provided, to obtain credit or background reports as permitted by law, and to make any other inquiries necessary to establish and maintain the account. I further certify that I am not subject to any sanctions, denied-party, or prohibited-party lists, and I will promptly notify the institution if I become subject to such a restriction.

The account will be governed by the institution's standard account agreement and fee schedule. By signing below I agree to be bound by those terms and any amendments provided in writing.

I consent to receive account disclosures, statements and notices electronically where permitted.

I have read, understand, and agree to the certifications and terms set forth in this application.

Additional Information / Special Instructions

Certification and Signature

By signing below I certify, under penalty of perjury, that the information provided on this form is accurate, that I am authorized to open this account, and that I will promptly notify the institution of any material changes. I acknowledge that the institution may retain this form and related documentation in accordance with its recordkeeping policies.

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