Account Authorization

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 us. 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 personal account the Bank will request copies of a valid government issued photo ID as well as proof of mailing address. Additionally, if prior banking history has not yet been established the bank will require proof of social security identification. I further authorize the financial institution to verify credit and employment history and/or have a credit reporting agency prepare a credit report on the account holders, as individuals. I agree to update the Bank promptly with any changes to the information entered in this application.