Account Authorization/Beneficial Ownership Certification
Giving your correct Taxpayer Identification Number and making the appropriate certifications will prevent certain payments from being subject to backup withholding. Under penalties of perjury, I certify that: (1) The number shown on this form is the applicable correct Taxpayer Identification Number and (2) I am not subject to backup withholding either because I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interests or dividends, or the IRS has notified me that I am no longer subject to backup withholding. If you are subject to backup withholding, please contact Applied Bank at 888-839-7952. The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding.
When opening your new business account, the Bank will request copies of a valid government issued photo ID as well as proof of business address. Additionally, if prior banking history has not yet been established the bank will require proof of social security identification.
By submitting this application, I authorize the financial institution to verify credit and employment history and/or have a credit-reporting agency prepare a credit report on the Authorized Signers listed, as individuals. The Business undertakes to inform Bank of any change in the information provided in this application, promptly. I hereby agree to the contents of this application and confirm all details provided therein valid, effective and binding and the same may be deemed to be true and correct. I certify that the provided beneficial ownership information is current and valid as of this date.