COMMERCIAL ACCOUNT APPLICATION

______

TYPE OF ENTITY OWNERSHIP

Corporation Type:

(___ ) Corporate (for Profit)(___) Corporate (Non-Profit)(___) Professional Association (PA)

Partnership Type:

(___) General(___) Joint

(___)Limited Liability Partnership (LLP)(___)Limited Liability Company (LLC/LC)

(___) Limited Partnership (LP)

Miscellaneous Type:

(___) Sole Proprietorship(___) Unincorporated Association (Clubs, Groups, Organizations)

(___) Government Entity(___) IOLTA

(___) Escrow Accounts(___) Other ______

TYPE OF COMMERCIAL ACCOUNT

(___) Small Business Checking (___) Commercial Account(___) Money Market

(___)Super NOW(___) Certificate of Deposit

Account Name:______

DBA (Assumed Name):______

Office Physical Address:______

City:______State:______Zip:______

Statement Address (if different): ______

City:______State:______Zip:______

Previous Address of Business:______

City:______State:______Zip:______

Website/Email Address:______

Description of Principal Line of Business:______

Names of Two (2) Major Suppliers or Clients:______

Gross Annual Sales:______Existing Heritage Customer: (___)Yes (___)No

Company Tax ID #
Company Phone
Company Fax
Company Contact
Date Entity Est.
Type of Entity
Former Financial Inst.
Number of Signatures for Withdrawal?
Will facsimile signatures be used?
Purpose of Account
Number of Locations?
Number of Employees?
Should this account be grouped with
existing accounts?

FOR CORPORATE RESOLUTION:

President
Vice President
Treasurer
Secretary

Please have each authorized signer complete the attached form

Authorized Signer 1 / Authorized Signer 2
Title / Title
Physical Address / Physical Address
(required) / (required)
Social Security # / Social Security #
Driver's License # / Driver's License #
Issued By / Issued By
Exp. Date / Exp. Date
Date Of Birth / Date Of Birth
Home Telephone / Home Telephone
Work Telephone / Work Telephone
Employer / Employer
Occupation / Occupation
Email Address / Email Address
Authorized Signer 3 / Authorized Signer 4
Title / Title
Physical Address / Physical Address
(required) / (required)
Social Security # / Social Security #
Driver's License # / Driver's License #
Issued By / Issued By
Exp. Date / Exp. Date
Date Of Birth / Date Of Birth
Home Telephone / Home Telephone
Work Telephone / Work Telephone
Employer / Employer
Occupation / Occupation
Email Address / Email Address

Customer Certification and Authorization

The undersigned acknowledges receipt of at least one copy of the Rules and Regulations Governing Accounts. The Funds Availability Policy, and the schedule of fees thereof, on the date stated below. The bank is authorized from time to time, and without notice to me, to obtain credit information history and to confirm my employment history. I certify that the above information is true and complete, and authorize you to verify the above information and to obtain further information concerning credit history and standing and deposit accounts maintained with other institutions. I confirm that all credits to the account are and will be beneficially owned by the named business entity. I agree to notify you, within 30 days, of any changes to the foregoing information.

______

Signature of Authorized RepresentativeDateSignature of Authorized RepresentativeDate

______

Signature of Authorized RepresentativeDateSignature of Authorized RepresentativeDate

To help us determine which services are right for you, please answer the following questions about how you will be using your new account.

What is the Purpose of the account? ______

What type items do you expect to be deposited in the account?

___ Cash___ Checks___ Direct Deposit___ ACH___ Wire Transfer

How frequently will deposits be made?______

Estimate the amount of deposits $______

Estimate the average balance in the account $______

What methods do you expect to use to remove funds from the account?

___ Checks___ ATM___ Debit Card___ Automated Bill Pay___ Wire Transfer

Do you anticipate receiving funds from outside the US or sending funds outside the US? _____

Are you or any of your relatives or associates connected to the government of a country other than the US? ____

Where is the business organized?______

What is the type of business?______

Is the business cash intensive?______

Will your business be engaged in any of these activities?___ Check Cashing ___ Currency Dealing / Exchange

___ Money Orders___ Traveler’s Checks___ Stored Value Cards___Money Transfer Services

The business entity identified below certifies that it does not engage in an Internet gambling business within the meaning of Federal Reserve Regulation GG ______

(Business Entity) ( Date)

FOR BANK USE ONLY

DATE OPENED: ______ACCOUNT #: ______ACCOUNT TYPE: ______

BRANCH:______RESP. CODE: ______RISK RANKING: ______

NAICS CODE: ______INITIAL DEPOSIT: ______SOURCE OF FUNDS: ______

HOLD PLACED: ______/ ______

Amt. of Hold# of days

CD TERM: ______Opened By: ______Date: ______

INTEREST: (__) Compound (__) Credit Account # ______(__) Check Order(__) Debit Card Application (if applicable)

Nature of Business (bespecific):______

Special Instructions:______

Revised 1/7/2015Page 1