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. Provide first, middle and last names on all individuals. Date of Birth is to be in mm/dd/yyyy format. Forms that are returned with missing information will cause delays in processing. Do not leave any section blank unless instructed to do so. If additional space is needed, you may attach additional pages. Abbreviations or acronyms are not acceptable. P.O. Boxes are not acceptable in address. You must notify U.S. Bank if any information contained in the form changes during your relationship with us.

Company Information

Company (Legal Entity) Name
Please include legal structure of business (e.g., Corporation, Limited Partnership/LLP, Not-for-Profit Organization, LLC). 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 Type: TIN, EIN or SSN
For a Sole Proprietorship, a Non-U.S. business identification number from a government-issued document certifying the existence of a business or enterprise.
Identification Number
Must be a 9 digit number
Physical Business Address
For home base business, use residential address
PO Boxes are not acceptable
Does your company have a Doing Business As (DBA)/Assumed Name/Fictitious Name?

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 those that apply. Complete Sections A and B.
  • If NO, 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 or majority owned (51% or greater) subsidiary of a Publicly Traded Parent (this only applies to U.S. Operations and entities)
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
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, Trustees/Protectors, Living Grantors/Settlors, Guarantors, Executor)

Requirements:

  • Account Opener 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.
  • A Trustee, Living Grantor/Settlor and Beneficiary are the individual(s) who are related to any Trust listed in Section C.
  • If there are more than four (4) individuals, make a copy of the form and complete it.

Please fill out one of the following for each party:

  • 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

Trustee/Protector of trust that owns this company

Living Grantor/Settlor of trust that owns this company

Guarantor - An individual that is being added as a separate personal guarantor to this program

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

Trustee/Protector of trust that owns this company

Living Grantor/Settlor of trust that owns this company

Guarantor - An individual that is being added as a separate personal guarantor to this program

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

Trustee/Protector of trust that owns this company

Living Grantor/Settlor of trust that owns this company

Guarantor - An individual that is being added as a separate personal guarantor to this program

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

Trustee/Protector of trust that owns this company

Living Grantor/Settlor of trust that owns this company

Guarantor - An individual that is being added as a separate personal guarantor to this program

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. Do not include those under that percentage.
  • If there is any individual with LESS than 25% ownership that controls, manages or directs the business, please include them as well.
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
  • Trust - Identification Number
  • 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
  • Trust - Identification Number
  • 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
  • Trust - Identification Number
  • 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
  • Trust - Identification Number
  • 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)
Check one of the boxes below if:

No other individual holds more than 25%

No individual holds more than 25%

Section C-2: List one individual with responsibility to control, manage or direct the business

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

I, the Account Opener, hereby certify that to the best of my knowledge, the information provided about me, the name and address provided for the legal entity customer and the beneficial owner(s) and/or the individual with control over the legal entity customer is complete and accurate.

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