Financial Signature Application

FINANCIAL SIGNATURE APPLICATION

Organization Information

Applicant / Requestor Information

Applicant Name:

Job Title:     Employee ID:

Requested Authorities (select all that apply)

Sign checks and negotiable instruments on behalf of the organization

Initiate or approve domestic and international wire transfers

Authorize ACH credits and debits

Approve payroll disbursements and adjustments

Manage corporate credit cards and limits

View account information and obtain account statements

Authority Limits and Scope

Per-transaction maximum authorized amount: $     Daily aggregate limit: $

Authority effective date:     Expiration date (if any):

Accounts to Which Authority Applies

Account 1 — Bank Name: Account Number:

Account 2 — Bank Name: Account Number:

Account 3 — Bank Name: Account Number:

Identification and Required Attachments

Provide copies of the following documents (check all that are attached):

Corporate resolution or minutes authorizing signatory

Government-issued photo identification for applicant

Specimen signature card (if required)

Other supporting documentation (describe below)

Certification, Representations and Agreement

By submitting this Financial Signature Application, the applicant certifies that the information provided is true, complete and accurate to the best of the applicant's knowledge. The applicant represents that they are duly authorized by the organization to request the authorities indicated and that the organization has adopted and maintains corporate governance documentation that authorizes the requested delegation.

Applicant agrees to comply with all applicable banking and internal control policies, to safeguard authentication credentials, and to promptly notify the organization's finance department and the relevant financial institution of any change in authority, termination of employment, or suspected compromise. The organization will indemnify and hold harmless the financial institution and its agents for actions taken in reliance on this application consistent with the scope of authority granted herein.

False statements made in this application may result in disciplinary action and may subject the applicant and the organization to civil or criminal penalties under applicable law. The organization authorizes the financial institution to verify any information provided in connection with this application.

Internal Use Only

Approval Status: Approved Denied

Acknowledgment and Signature

The undersigned warrants that they are authorized to bind the organization with respect to the authorities requested. The undersigned acknowledges that the organization and the applicant remain subject to the organization's internal policies and that the financial institution may require additional verification prior to actioning requests.

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