Know Your Customer

Required Information Collection Form

To help the United States government fight the funding of terrorism and prevent money laundering activities, U.S. Federal law requires all financial institutions to obtain, verify, and record information that identifies each person (individual, corporation, partnership, trust, estate, or any other entity recognized as a legal person) who opens an account. U.S. Bank will ask for the legal name, address, tax identification number, and other identifying information that will assist us in completing the review of contract/application. We may also ask for copies of certified articles of incorporation, an unexpired government-issued business license, a partnership agreement, or other documents that indicate the existence and standing of the entity. U.S. Federal law also requires financial institutions to conduct ongoing customer due diligence, verify the identity of beneficial owners of certain legal entities, and comply with U.S. Economic Sanctions. U.S. Bank may require identification information on Customer, its Affiliates, Related Parties, or Cardholders, if applicable, to allow U.S. Bank to remain in compliance with U.S. Federal law or U.S. Bank policy. Customer agrees to promptly provide such identification information to U.S. Bank, and Customer shall cause its Affiliates, Related Parties or Cardholders, if applicable, to provide identification information to U.S. Bank.


Customer Information

Answer all questions completely and thoroughly, reviewing the requirements of each section. Do not leave any section blank unless you qualify under Section B. Provide the First, middle (if applicable), and last name for all individuals supplied on this form. Missing information will cause delays in processing. Abbreviations or acronyms are not acceptable. Post Office Boxes or Personal Mailboxes are not acceptable, please provide physical address for any addresses provided. You must notify U.S. Bank if any information contained in the form changes.

Company Information

Company Name
Please include legal structure of business (e.g., Corporation, Limited Partnership/LLP, Not-for-Profit Organization, LLC, Single Member LLC, Sole Proprietor). Provide the full legal name of the customer as it is captured on formation documents, this does not include DBA/Trade names or Operating As names. Examples include Articles of Incorporation, Partnership Agreements, etc. If the entity is a Sole Proprietorship, provide the full legal name, first, middle, last, of the Owner.
Identification Number - (TIN/EIN or an SSN/ITIN if your business does not have its own EIN)
Must be a 9 digit number
Physical Business Address
For home base business, use residential address
PO Boxes & Personal Mailboxes are not acceptable
Does your company have a Doing Business As (DBA)/Assumed Name/Fictitious Name that are applicable to your relationship with U.S. Bank?

Yes

No

DBA 1

DBA or Trade Name
Provide the DBA address if it is different than the company address
Same as Physical Business Address above

DBA 2

DBA or Trade Name
Provide the DBA address if it is different than the company address
Same as Physical Business Address above

DBA 3

DBA or Trade Name
Provide the DBA address if it is different than the company address
Same as Physical Business Address above

DBA 4

DBA or Trade Name
Provide the DBA address if it is different than the company address
Same as Physical Business Address above

Business Type

Do any of the below business types apply to your business?
  • If YES, check only one. Complete Sections A and B.
  • If NONE of these apply, complete the entire form.

U.S. Department or Agency of any Federal, State or Political Subdivision, including Tribal governmental entities

U.S. Political Subdivision

Financial institution that is regulated by a Federal or State Regulator

Any entity established under an interstate compact, including Indian Tribal Governmental Entities

An entity that is listed on the New York, NYSE Market LLC or NASDAQ stock exchanges - this only applies to U.S. operations
Name of Exchange
Ticker Symbol

Subsidiary of a Publicly Traded parent - this only applies to U.S. operations and entities where equity of 51% or more is held by a listed entity
Name of Exchange
Ticker Symbol

Section A: Standard Due Diligence Questions - This section is required to be completed by all applicants

What is the nature of your business?
Include NAICS if known
What is the legal structure of your business?
e.g., Corporation, Limited Partnership/LLP, Not-for-Profit Organization, LLC, Single Member LLC, Sole Proprietor
What is the company’s country of formation?
What is the country of primary business operations for the company?
What is the company’s expected monthly value of incoming and outgoing international (outside of the U.S.) activity? (USD)
$
Whole numbers only (e.g., 1000). No commas or decimal places. If no international activity expected, 0 is acceptable.
What is the company’s estimated or projected annual revenue/budget? (USD)
$
Whole numbers only (e.g., 1000). No commas or decimal places.
What is the purpose of the account?
Does the company provide any of the following services?
If yes, check those that apply.

Check cashing services

Issue or cash travelers checks or money orders

Provide money transmission or foreign exchange services

Offer prepaid cards

Section B: Related Parties (Authorized Signers, Executor)

Requirements:

  • Authorized signer is the individual(s), who signed the Corporate Payment Systems (CPS) contract document(s) on behalf of the company. This is required for all entities each time this form is completed. The account opener must be a Member or Manager of an LLC, Partner of a Partnership, Business Owner, CEO, Controller or other individual who performs a similar function.

Please fill out one of the following for each individual:

  • Full Name and Date of Birth
OR
  • Physical Address
OR
  • SSN
First Name
Middle Name
No Middle Name
Last Name
Date of Birth
(mm/dd/yyyy)

Physical Residential Address (preferred) or Business Address
PO Boxes are not acceptable

Residential

Business

SSN
(###-##-####)
Role

Authorized Signer

Executor of Estate that may own this company

Party 2

First Name
Middle Name
No Middle Name
Last Name
Date of Birth
(mm/dd/yyyy)

Physical Residential Address (preferred) or Business Address
PO Boxes are not acceptable

Residential

Business

SSN
(###-##-####)
Role

Authorized Signer

Executor of Estate that may own this company

Party 3

First Name
Middle Name
No Middle Name
Last Name
Date of Birth
(mm/dd/yyyy)

Physical Residential Address (preferred) or Business Address
PO Boxes are not acceptable

Residential

Business

SSN
(###-##-####)
Role

Authorized Signer

Executor of Estate that may own this company

Party 4

First Name
Middle Name
No Middle Name
Last Name
Date of Birth
(mm/dd/yyyy)

Physical Residential Address (preferred) or Business Address
PO Boxes are not acceptable

Residential

Business

SSN
(###-##-####)
Role

Authorized Signer

Executor of Estate that may own this company

Section C-1: Beneficial Ownership

Requirements:

  • Only list the individual(s) who directly or indirectly own 25% or more of the Company Name listed in the Company Information Tab. Do not include those under that percentage.
  • If a trust owns 25% or more of the Company Name listed in the Company Information Tab, provide the information of the individual trustee(s) below, if the trustee is a non-individual, provide the information of the non-individual trustee below in the Non-Individual Trustee Beneficial Owner Information section
Check Box IF, no individual holds more than 25% ownership directly or indirectly for the listed above then proceed to Section C-2
First Name
Middle Name
No Middle Name
Last Name
Date of Birth
(mm/dd/yyyy)
Residential Address (preferred) or Business Address
PO Boxes are not acceptable

Residential

Business

Identification Number Type
  • U.S. individuals – SSN/ITIN
  • Non-U.S. individual – SSN or Passport Number, Country of Issuance, Issuance & Expiration Dates or other similar identification number and information Copy of Non-Expired Document is required
Identification Number
Must be a 9 digit number
Ownership Percentage
%
Whole numbers only (e.g., 25)

Owner 2

First Name
Middle Name
No Middle Name
Last Name
Date of Birth
(mm/dd/yyyy)
Residential Address (preferred) or Business Address
PO Boxes are not acceptable

Residential

Business

Identification Number Type
  • U.S. individuals – SSN/ITIN
  • Non-U.S. individual – SSN or Passport Number, Country of Issuance, Issuance & Expiration Dates or other similar identification number and information Copy of Non-Expired Document is required
Identification Number
Must be a 9 digit number
Ownership Percentage
%
Whole numbers only (e.g., 25)

Owner 3

First Name
Middle Name
No Middle Name
Last Name
Date of Birth
(mm/dd/yyyy)
Residential Address (preferred) or Business Address
PO Boxes are not acceptable

Residential

Business

Identification Number Type
  • U.S. individuals – SSN/ITIN
  • Non-U.S. individual – SSN or Passport Number, Country of Issuance, Issuance & Expiration Dates or other similar identification number and information Copy of Non-Expired Document is required
Identification Number
Must be a 9 digit number
Ownership Percentage
%
Whole numbers only (e.g., 25)

Owner 4

First Name
Middle Name
No Middle Name
Last Name
Date of Birth
(mm/dd/yyyy)
Residential Address (preferred) or Business Address
PO Boxes are not acceptable

Residential

Business

Identification Number Type
  • U.S. individuals – SSN/ITIN
  • Non-U.S. individual – SSN or Passport Number, Country of Issuance, Issuance & Expiration Dates or other similar identification number and information Copy of Non-Expired Document is required
Identification Number
Must be a 9 digit number
Ownership Percentage
%
Whole numbers only (e.g., 25)
Non-Individual Trustee Beneficial Owner Information
  • Complete this section if you are a non-individual trustee (e.g., Business Trust), that owns 25% of the Company Name listed in the Company Information Tab
Company Name
Ownership Percentage
%
Whole numbers only (e.g., 25)
Physical Business Address
Identification Number
Must be a 9 digit number

Section C-2: List one individual with responsibility to control, manage or direct the business (e.g., a Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President, or Treasurer; or any other individual who regularly performs similar management functions.)

First Name
Middle Name
No Middle Name
Last Name
Date of Birth
(mm/dd/yyyy)
Title
Physical Residential Address (preferred) or Business Address
PO Boxes are not acceptable

Residential

Business

Identification Number Type
  • U.S. individuals – SSN
  • Non-U.S. individual – SSN or Passport Number, Country of Issuance, Issuance & Expiration Dates or other similar identification number and information Copy of Non-Expired Document is required
Identification Number
Must be a 9 digit number

Section D: Certification by Account Opener

This section must be completed by an appropriate individual with the authorization of the Customer provided in Section A at the top of this form. e.g., the secretary or other officer, a member or manager of an LLC, partner of a partnership, business owner, Chief Executive Officer (CEO), controller, Chief Operating Officer (COO), Chief Financial Officer (CFO).

I, an Authorized Officer of the company name listed in Section A above, hereby attest that all information supplied on this form and/or any documentation supplied as requested in this form is true and accurate to the best of my knowledge.

First Name
Middle Name
No Middle Name
Last Name
Title
Date
(mm/dd/yyyy)
Signature
(hold mouse and drag to draw your signature)

Electronic Signature Agreement
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions.
I Accept