Aug-08-2012 08:12 AM BANK OF AMERICA¶
8/19¶
(THE “BANK”)¶
Personal Signature Card with Substitute Form W-9¶
□ Temporary Signature Card (deposit accounts only)¶
Account Type MYACCESS CHECKING¶
By signing below, I/we acknowledge and agree that this account is and shall be governed by the terms and conditions set forth in the following documents, as amended from time to time: (1) if this account is a deposit account, the Deposit Agreement and Disclosures, the Personal Schedule of Fees and the Miscellaneous Fees for Personal Accounts, and (2) if this account is a Line of Credit, the Line of Credit Agreement and Disclosures. Furthermore, I/we acknowledge the receipt of these documents. A joint account is the property of each co-owner as joint tenants with right of survivorship and payable to either co-owner or to the surviving co-owner(s) if a co-owner dies. By signing below, I/we also acknowledge and agree that the signature(s) will serve as verification for any transaction in connection with this account, any Line of Credit checks which I/we may sign, and as the certification (set forth below) of the taxpayer identification number to which I/we want interest reported.¶
Substitute Form W-9. (Required only for Deposit Accounts) Certification- Under penalties of perjury, I certify that:¶
The number shown on this form is the correct taxpayer identification number (or I am waiting for a number to be issued to me), and (2) I am not subject to backup withholding because: (A) I am exempt from backup withholding, or (B) 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 interest or dividends, or (C) The IRS has notified me that I am no longer subject to backup withholding, and (3) I am a U.S. citizen or other U.S. person (as defined in the instructions).¶
You must cross out item (2) above if you have been notified by the IRS that you are currently subject to backup withholding because of underreporting interest or dividends on your tax return. (See also IRS instructions for Form W-9).¶
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.¶
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By checking the box marked “ATM/Check Card Requested?”, I/were hereby request an Automatic Teller Machine Card and/or a Check Card. By signing below, I consent to the issue of an ATM Card and/or Check Card to the other account holders indicated above.
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For Massachusetts only - By checking the box marked “ATM/Check Card Requested?”, I hereby request an ATM Card and/or Check Card. By signing this Signature Card, I consent to the issuance of an ATM Card and/or Check Card to any of the account holders of this account.
Bank Information¶
Custom Information¶
Review Information ___¶
Customer 2¶
Name ___¶
Review Information ___¶
Customer 3¶
Name ___¶
Review Information ___¶
Customer 4¶
Name ___¶
Review Information ___¶
Customer 5¶
Name ___¶
Review Information ___¶
Date ___ 08/07/2012¶
Banking Center Name PELHAM PARKWAY¶
Associate’s Name ___¶
Associate’s Phone Number ___¶
NNY 951-14-9009M 10-2009¶
EFTA00123687¶