Business Deposit Application

Filling out section 1 of 6

* Indicates required field

Tell us about your business:

Sole Proprietor Government Entity

Partnership Trust

Corporation Association

LLC Other

Business Name *

Date Of Establishment *

Tax ID #/Employer ID *

Physical Address *

City *

State *

Zip Code *

Mailing Address (if different from above)

City

State

Zip Code

Business Phone Number *

Cell Phone Number *

Business Fax Number

Website Address

Email Address *

Type Of Business - retail, manufacturing, etc. *

NAICS Code *

https://www.census.gov/cgi-bin/sssd/naics/naicsrch

Account(s) you are interested in:

Filling out section 2 of 6

* Indicates required field

Beneficial Owner Information:

Anyone who owns 25% or more of the entity, directly or indirectly.

First Name *

Last Name *

MI *

Date Of Birth *

ID Number *

State Of Issuance *

Expiration Date *

First Name

Last Name

MI

Date Of Birth

ID Number

State Of Issuance

Expiration Date

First Name

Last Name

MI

Date Of Birth

ID Number

State Of Issuance

Expiration Date

First Name

Last Name

MI

Date Of Birth

ID Number

State Of Issuance

Expiration Date

Individual with Entity Control:

A single person who manages, controls, or directs the entity.

First Name *

Last Name *

MI *

Date Of Birth *

ID Number *

State Of Issuance *

Expiration Date *

Filling out section 3 of 6

* Indicates required field

Business Identification Provided:

Check which one you are providing to open account:*

Sole Proprietor

Certificate Of Assumed Name Certificate Of Good Standing

Corporation

Articles Of Incorporation Certificate Of Incorporation Certificate Of Good Standing

Trust

Trust Agreement

EIN Letter from IRS - must obtain for all

Filling out section 4 of 6

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Tell us about your business activity:

Purpose Of Account - General Business, Payroll, Money Transfers, Savings, etc. *

Primary Geographic Trade Area *

Location Of Headquarters *

Do you plan to originate ACH Transactions?* No Yes

Does your business usually generate over $5,000 of cash deposits or withdrawals per day?* No Yes

Do you plan to initiate or receive domestic wires? * No Yes

Do you plan to initiate or receive foreign wires?* No Yes

Do you own and operate any ATMs? * No Yes

Does your business offer currency exchange to your customers?* No Yes

Does your business issue, sell, or redeem monetary instruments? - Travelers Checks, Travel Cards, Official Checks, Money Orders* No Yes

Does your business issue, sell, or redeem stored value cards?* No Yes

Does your business provide money transfer services? - Money Grams, Western Union* No Yes

Does your business cash checks, exchange currency, or sell monetary instruments in amounts greater than $1,000 for any one person on any one day in one or more transactions?* No Yes

Does your business operate as an internet gambling business?* No Yes

Filling out section 5 of 6

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Must be answered by all applicants:

Have you had a transaction account at this or another financial intermediary within 12 months of making this application?

Applicant 1:*

No Yes