Financial Account Documents

FINANCIAL ACCOUNT DOCUMENTS

This Financial Account Documentation and Authorization Form collects required information, acknowledgments, and certifications necessary to open, maintain, or modify one or more financial accounts. Client Name:   Date of Application:

1. Account Holder Information

Entity Type: Individual Corporation LLC Partnership Trust Other

2. Account Details & Services Requested

Requested Account Type: Checking Savings Brokerage Retirement Custodial Other

Funding Method: Check Wire Transfer ACH Debit Cash Other

3. Authorized Signatories

Provide all individuals authorized to transact on the account. Additional signatories may be attached on a separate page signed by an authorized officer.

Write checks Initiate wires Initiate ACH

4. Beneficial Owners (for entities subject to ownership rules)

List individuals with ownership or control of 25% or more, and the individual with significant managerial control. Attach additional sheets as necessary.

5. Documentation Checklist

The following documents are provided with this application (check all that apply):

6. Terms, Representations, and Certifications

By signing below, the Account Holder represents and warrants that all information provided in this form and in the supporting documentation is true, complete, and correct. The Account Holder certifies that it has the full legal authority to open and maintain the requested accounts and to execute any account agreements, and that the persons listed as authorized signatories have the authority described.

The Account Holder acknowledges and agrees that the financial institution will rely on the representations in this form until it receives written notice of any change. The Account Holder will promptly notify the institution of any material change to ownership, control, or authority. The Account Holder consents to identity verification and background screening, including obtaining consumer or business credit reports where permitted by law.

The Account Holder acknowledges the institution's right to refuse to open or to close an account for any lawful reason, including compliance with anti-money laundering and sanctions obligations. The Account Holder agrees to indemnify and hold harmless the institution for reliance on the information provided and for actions taken in accordance with account instructions provided by authorized signatories.

Governing Law: This agreement shall be governed by the laws of the state indicated below, without regard to conflict-of-law principles. State:

Electronic Delivery Consent: The Account Holder consents to receive statements, disclosures, notices, and other communications electronically where permitted. The Account Holder may revoke electronic consent in writing subject to institution procedures.

Fees and Charges: The Account Holder acknowledges responsibility for fees and charges applicable to the account as disclosed in the institution's fee schedule. The institution may change fees upon notice as permitted by law or the account agreement.

I certify that I am authorized to execute this form and that the information and documents provided are accurate and complete to the best of my knowledge.

7. For Financial Institution Use Only

Sign Now