Business Account Information Form

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT:

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When an account is opened or a signer is added, we will ask for your name, address, date of birth (for individuals) and other information that will allows us to identify you or the business. We may also ask to see your driver’s license or other identifying documents. 

"*" indicates required fields

General Business Information

Address*
Primary Trade Area*
 

Do you offer any of the following services? (check that all apply)

SERVICES

If you checked any of the bolded items above, please upload a copy of the MSB registration below.

Does your business engage in transactions greater than $1,000 for any person on any day in one or more transactions?*
 

Authorized Signer Information

Please upload a copy of your driver's license below.

AUTHORIZED SIGNER #1
AUTHORIZED SIGNER #2
AUTHORIZED SIGNER #3
AUTHORIZED SIGNER #4
AUTHORIZED SIGNER #5
   

Beneficial Ownership Information

Please upload driver's licenses for all beneficial owners below.

The following information for each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity listed above. If no individual meets the definition, please write “Not Applicable”.

BENEFICIAL OWNER #1
MM slash DD slash YYYY
BENEFICIAL OWNER #2
MM slash DD slash YYYY
BENEFICIAL OWNER #3
MM slash DD slash YYYY
BENEFICIAL OWNER #4
MM slash DD slash YYYY
 
Please scan and upload any applicable documentation (e.g. Driver's licenese, MSB registration)
Drop files here or
Accepted file types: jpg, pdf, png, doc, docx, Max. file size: 50 MB.