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PointBank Business Account Application

Apply for:

 

Commercial Checking
 

Commercial NOW

 

Commercial Money

Market Bonus Account

 

Positively Free Small Business Checking

 

Commercial Savings Account

 

Positively Free Non-Profit Commercial Checking

"Regulations prohibit "partnerships" and "for-profit corporations" from holding NOW Accounts."


Check One:      Corporation     Sole Proprietorship  Joint Venture    LLC

     General Partnership     Limited Partnership    Non-Profit Association Other

Name of Business: 
                                              (For Corporations, as shown on Articles of Incorporation)

 For Corporations Only

 Name of Account: 
                                                       (Example: ABC, Inc. Employee's Retirement Trust)

Business Street Address:

City:    State: Zip:

 Mailing Address:  Street:

City:    State: Zip:

Business Phone:  Fax Phone:  

Website:

Tax ID Number:  Type of Business:

Contact Person: Phone Number:  

Email:

Statement: Mailed  Held for Pick-up

Statement Mailing Address:    Business  Other

Former Banking Relationship:  

Referred By:


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Personal Information on Each Signer

Name:

Name:

Title:

Title:

Authorized  to Withdraw Funds from this Account?                    Yes   No

Authorized  to Withdraw Funds from this Account? Yes  No

Driver's License Number:

Driver's License Number:

Social Security Number:

Social Security Number:

Date of Birth:   

Birth Place:

Date of Birth:    

Birth Place: 

Mother's Maiden Name:

Mother's Maiden Name:

Home Telephone:

Home Telephone:


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Name:

Name:

Title: 

Title: 

Authorized  to Withdraw Funds from this Account? Yes  No

Authorized  to Withdraw Funds from this Account? Yes  No

Driver's License Number:

Driver's License Number:

Social Security Number:

Social Security Number:

Date of Birth:

Birth Place:

Date of Birth:

Birth Place:

Mother's Maiden Name:

Mother's Maiden Name:

Home Telephone:

Home Telephone:


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Name:

Name:

Title: 

Title: 

Authorized  to Withdraw Funds from this Account? Yes  No

Authorized  to Withdraw Funds from this Account? Yes  No

Driver's License Number:

Driver's License Number:

Social Security Number:

Social Security Number:

Date of Birth:

Birth Place:

Date of Birth:

Birth Place:

Mother's Maiden Name:

Mother's Maiden Name:

Home Telephone:

Home Telephone:


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I understand that this is an application for an account(s) with PointBank and is subject to approval. Everything that I have stated in this account agreement is correct to the best of my knowledge. You are authorized to check credit, company history and an inquiry into past banking relationships.

APPLICANT BACKUP WITHOLDING CERTIFICATION

Taxpayer ID Number: (If Taxpayer ID is same as your SSN, leave blank)

Certification

Under penalties of perjury, I certify that the following information is correct.

 

TAXPAYER ID NUMBER: My correct Taxpayer Identification Number (TIN) is shown above.

 

BACKUP WITHHOLDING: I am not subject to backup withholding because either I have not been notified of being subject to backup withholding as a result of failure to report all interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding.

 

EXEMPT RECIPIENTS: I am an exempt recipient under the Internal Revenue Service (IRS) Regulations.

 

NONRESIDENT ALIENS: I am not a citizen or a resident of the United States.

Under penalties of perjury, I /we certify that (1) the social security number(s), Taxpayer ID indicated above is/are my/our number(s)and (2) I/We am/are not subject to backup withholdings as a result of failure to report all interests or dividends, or the IRS has notified me that I am no longer subject to backup withholding.


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APPLICANT BACKUP WITHOLDING CERTIFICATION

Signature(s) -- The undersigned agree(s) to the terms stated in this form and acknowledge(s) receipt of a completed copy on today's date. The undersigned also acknowledge(s) receipt of a copy of and agree(s) to the terms of the following disclosure(s):

If the account(s) designated for this service are joint accounts, both account owners must sign this application.

Applicant Signature:
 

Date:


Co-Applicant Signature

 

Date:


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To open your account, we will need your signature and identification to be provided at any one of our locations for the new account documentation. Please drop by the location which is most convenient to you.

Thank you for giving PointBank the opportunity to serve you!


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