EFTA01481235.pdf

CHEMICAL PERSONAL SIGNATURE CARD Chemical Bank FOR BANK USE ONLY AND APPLICATION BRANCH COPY ACCOUNT TITLE (A JOINT ACCOUNT IS PAYABLE TO EITHER OWNER, OR THE SURVIVOR). 2 a t v•-r— itVhq-1 ACCOUNT NU ER - or 12 digits 4 BAC/PROF1T C 0712'1S 7- TAXPAYER IDENTIFICATION NU BER(S) PRIMARY APPUCANT'S TAXPAYER ID# 6 SECONDARY APPLICANT'S TAXPAYER ID 0 7 UGMA MINOR'S TAXPAYER ID 0 1 CHECK ACCOUNT ARRANGEMENT: CHECK ONE: 10 &<idividual 0 Joint 0 Estate/Trust 0 Other El None El UGMA D ITF D POA CHE5K ACCOUNT TYPE: 11 gehecking CI Checking with Interest 0 MMA '0 Savings NON-CREDIT UNCOLLECTED FUNDS AVAILABIUTY AND OVERDRAFT PROTECTION ("SERVICE") (*RESTRICTED TO NDS) 12 CHECK CASHING POWER° E] Yes, Savings/MMA/CD ACCT 0 No *CASH NOW." 0 Yes, Savings/MMA/CD ACCT 0 No 'COVERAGE NOWsu D Yes, Savings/MMA ACCT 0 No EFTA01481235 Please activate the Service selected above. I (we) authorize you to use the account identified above for uncollected funds availability and/or overdraft protection in connection with the Service. I (we) agree to the terms and conditions for the Service as contained in the Deposit Account Agreement and Disclosures. 7„, _ MI n /4FPF I/we agree that I/we have reviewed the information contained in this Personal Signature Card and Application and find it accurate on this date. In the payment of funds and in the transaction of all other business relative to this account. Vwe agree that you are authorized to rely upon the signature(s) written below and on the reverse side. Uwe have received and agree to the terms and conditions of.the Deposit Account Agreement and Disclosures currently in effect and as may be amended for the type of account and services I/we have selected above. If Vwe do not have a Chemical Banking Card, Vwe will be issued one/two and all eligible accounts will be linked to it/- them. These linked accounts, whether singly or jointly owned, can be accessed by the Chemical Banking Card or by telephone. During the review of my (our) application, the Bank may obtain a consumer report on me (us) and if the application is approved, the Bank may at any time in the future obtain additional consumer reports to review my (our) account. I (we) have the right to ask for the name and address of the consumer reporting agency which gave the consumer report. Under penalty of perjury, I (we) certify (1) that the number(s) shown on this form is my (our) correct taxpayer identification number(s) and (2) that I (we) ant/are not subject to backup withholding either because: (a) I (we) am/are exempt from backup withholding, or (b) I (we) have not been notified that I (we) am/are subject to backup withholding as a result of a failure to report all interest or dividends, or (c) The Internal Revenue Service has notified me (us) that I (we) am/are no longer subject to backup withholding. (If you have in fact been notified by the IRS that you are subject to backup withholding due to notified payee underreporting, please strike out the appropriate phrases within the certification.) APPUCANT SIGNATURE EFTA01481236  CI Check if there are additional account signers on reverse. LINE OUT UNUSED SIGNATURE BOXES. 15 THE ABOVE INFORMATION AND (NO.) Z. SIGNATURE(S) PRIMARY AND JOINT IF APPUCABLE) WERE VERIFIED BY. (16) rs' ALEX PEREZ Dept. No A51_ No. 7_ Print Name (17) ARMSTAMT MANAGER In - lie 19) ENTER ON REVERSE SIDE ALL PERTINENT POWER OF ATTORNEY AND/OR BENEFICIARY INFORMATION. 7(10-96) 4 4 BRANCH COPY - DO NOT SEND TO SIGNATURE VERIFICATION 444 POWER OF ATTORNEY INFORMATION OATOROFOMRECEIvED 38 POWER OF ATTORN 7 ADD ES ' Nu 9 4 . " I Z-- : / 3'3E CITY ST POWER OF AT1Tr ,;IGNATI1 E 40 7 X BENEFICIARY INFO • • N , ra. account complete the following information for your ne BENEFICIARY NAME 41 ADDRESS (Street ' 42 CITY STATE ZIP D BENEFICIAJRY DAT OF BIRTH 43 T PAYER IDENTIFICATION NUMBER available)RELA11ONSHIP TO DEPOSITOR45 I I I I I I I I ADDITiONAL ACCOUNT SIGNERS - (For Estate and Trust accounts, as needed)Line out unused Signature boxes PAINTED NAME TITLE SIGNATURE 46 748 EFTA01481237  48 47 x 48 46 47 48 X CHEXSYSTEMS CALLED? 490 Yes 500 No, explain why: SSN RESPONSE: YEAR: STATE: 51 52 ID RESPONSE: I 53 NOTARY INFORMATION (For Worldwide Consumer Bank/Chemical Direct Division Only) 54 STATE OF COUNTY OF ss.: li On the day of 19 before me personally came to me knotiyn, and known to me to be the individual described in, and who executed the foregoing instrument, and he acknowledge to me that he executed the same. EFTA01481238 THE ABOVE INFORMATION AND (NO.) SIGNATURE(S) (POWER OF ATTORNEY, ADDITIONAL SIGNERS) WERE VERIFIED BY: (55) Print Name (56) Initials (57) Dept. No./&1(o. (58) Retain card in branch for year after account closes. Then send to Pawling for additional retention of six years. BRANCH COPY — DO NOT SEND TO 4 03 9019'(Back)(10-95) # SIGNATURE VERIFICATION • REPRESENTATIVE CASHING AUTHORITY SIGNATURE CARD TO: DATE: 4-- CHEMICAL BANK 71/341- ACCOUNT TITLE: ACCOUNT NUMBER: (T. tS LA w Y14 h X Lu C I) 2 ) 0 0 3 r2- Gentlemen: Please cash any checks bearing my/our signature (or endorsement) when presented by my/our representative V-EA)/10 F Ll /..,c It is requested that he (she, they) be permitted to cash checks, in my (our) behalf, that bear either my (our) signature(s) or endorsement(s) when presented. In consideration of the foregoing, I (we) agree to indemnify and hold you harmless from any costs, claims, demands, suits, expenses, counsel fees, judgements or liabilities whatsoever arising from any such transaction, to the extent that they relate to or involve claims of forged signature, forged en- dorsements, or alteration. These instructions shall remain in effect until written revo been received. EFTA01481239  ATVESI1 TU *Joint Accowi Both Account alders Must Sign -- Business Accounts Officer or Partner Must Sign With Title 03-1387* (1-93) ' REPRESENTATIVE CASHING AUTHORITY SIGNATURE CARD TO: DATE: CHEMICAL BANK 7/73 /f ACCOUNT TITLE: ACCOUNT NUMBER: NUMBER: CT fh' / 11/7XcUell C121 63 .2 rFG26r Gentlemen: Please cash any .cpecks bearing my /o signature (or endorsement) when presented by my/our representative — It is is requested that he (she, they) be permitted to cash checks, in my (our) behalf, that bear either my (our) signature(s) or endorsement(s) when presented. In consideration of the foregoing, I (we) agree to indemnify and hold you harmless from any costs, claims, demands, suits, expenses, counsel fees, judgements or liabilities whatsoever arising from any such transaction, to the extent that they relate to or involve claims of forged signature, forged en- dorsements, or alteration. These instructions shall remain in effect until writtenhas been received. Si *Joint Accounts - Both Account Holders Must Sign — Business Accounts • Officer or Partner Must Sign With Tille 031387 (1-93) EFTA01481240  N CHEMICAL PERSONAL SIGNATURE CARD fODAY'S DATE _ ACCOUNT TITLE (4 Joint account is payable to either owner or the survivor). • 61-?1 1131 CII 5 & 14 I S kl- )1/ 1 h- V • DATE ACCOUNT OPENED ACCOUNT NUMBER AC NO. 0171 )IM 1.r 9 ),I1 oioj3ii9ii Olndividual OITF °Fiduciary Trust °Tenants In Common °Joint D UGMA °Estate °Custodian DOther OChecking OChecking with Interest/NOW OMMA °Savings 00lher I (we) agree that I (we) have reviewed the information contained in this Signature Card and the Personal Account Application and find it accurate on this date. I (we) have received and agree to the terms and conditions of the Deposit Account Agreement and Disclosures and the Chemical Banking Card Agitzment in effect from time to time for the type of account I(we) have selected. In addition, (certifywe) that the signature(s) presented on this Signature Card will revoke all prior signature(s) for this account. PR!i- iiLATURE JOINT APPLICANT SIGNATURE X X ACCOUNT INFORMATION DATE OF BIRTH (Primary Ap /cam) SOCIAL SECURITY NO. MOTHER'S MAiDEN NAME i I ), )-- I -ri IR I I 31 31.) 1 ki 'II ? if- 3 DATE OF BIRTH (Joint Applicant) SOCIAL SECURITY NO. OTHER' DEN NAME 1 1 1 1 I I I I II I .. EFTA01481241  Is this a revised Signature Card for an existing account? DYes io The information on this Signature Card has been verified by: fficer's Initials) ENTER ON REVERSE SIDE ALL PERTINENT POWER OF ATTOR EY AND/OR BENEFICIARY INFORMATION. POWER OF ATTORNEY POWER OF ATTORNEY NAME DATE POWER OF ATTORNkY FORM SIGNED ADDRESS S(rf nd Numbri CITY STATE ZIP CODE POWER OF ATTORNEY SIGNATURE X BENEFICIARY INFORMATION BENEFICIARY NAME (For a trust acrouni, complete the following information for your beneficiary). DATE ADDRESS (Sired and Number) CITY STATE ZIP CODE RELAT(ONSHtI TO TRUSTEE DATE OF BIRTH BIRTHPLACE // SOCIAL SECURITY NUMBER (if available) COUNTRY OF CITIZENSHIP REPRESENTATIVE CASHING AUTHORITY SIGNATURE CARD TO: DATE: CHEMICAL BANK ACCOUNT TITLE: EFTA01481242 ACCO Fl SL 2- 57 Z CS Gentlemen: Please cash any checks bearing my/ our signature (or endorsement) when presented by my/our iii representative SPA Et A LT-6-4-r It is requested that h (she, they) be permitted to cash checks, in my (our) behalf, that bear either my (our) signature(s) or endorsement(s) when presented. In consideration of the foregoing, I (we) agree to indemnify and hold you harmless from any costs, claims, demands, suits, expenses, counsel fees, judgements or liabilities whatsoever arising from any such transaction, to the extent that they relate to or in lye claims of forged signature, forged en- dorsements, or alteration. These instructions shall remain in effect until written onhas bee ceived, S. NTA 'VOW Is - Both Accou Must Sign — Business Accounts - Officer or Partner Must Sign With Title 03-1387 (143) - REPRESENTATIVE CASHING AUTHORITY SIGNATURE CARD TO; DATE: CHEMICAL BANK ACCOUNT TITLE: ACCOUN NUM R: G %SLV -ocD325yz -65 Gentlemen: Please cash any checks beiring,Ty/our signature (or endorsement) when presented by my/our representative SHANIA/OV It is requested that he (she, they) be pe ed to cash checks, in my (our) behalf, that bear either my (our) signature(s) or endorsement(s) when presented. In consideration of the foregoing, I (we) agree to indemnify and hold you harmless from any costs, claims, demands, suits, expenses, counsel fees, judgements or liabilities whatsoever arising from any such transaction, to the extent that they relate to or involve claims of forged signature, forged en- EFTA01481243 dorsements, or alteration. These instructions shall remain in effect until w RR ENTATIVESONAT *Joint Accounts - Both Account Holders Must Sign — Business Accounts • Officer or Partner Must Sign With Title 03-1387' (1.93) EFTA01481244