EFTA00123690.pdf

Bank of Americaca Personal Signature Card pA.NK .11.11itiCA ' with Substitute Form W-9 " Account Number ❑Temporary S:gnature Card (deposit accounts only) Account Type ING Account Tit'e By signing below, lwe 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: (I)if this account ie 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, Uwe acknowledge the receipt of these documents. A joint account is this property of each so-owner as feint tenants with right of survivorship and payable to either co-owner or to the sereiv co-owners) it a co-owner dies. By signing below, Uwe 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 Uwe may sign, and as the certification (set forth below) of the taxpayer identification number to which Uwe want interest reported. Substitute Form W.S. (Required only (or Deposit Accounts) Certification. Under penalties of perjury, I certify that/ (1) 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. person (Including a U.S. resident alien). Certification 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 avo d backup withholding. Report ATM/Check Card Interest Requested ? In Tax ether On (Deposit Accounts Only) 1. 2 3 4 6 • By checking the box marked 'ATM/Check Card Requested?', Unhereby 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. *For Massachusetts only . By checking the hoz marked 'AT/A/Check Card Requested?". I hereby request an ATM Card and/or Check Card. By signing this Signature Cant, I consent to the issuance of an ATM Card and/or Check Card to any of the account holders of this account. Bank Information Customer 1 Name US DRIVER PERMIT VI/MOM Review Information TRANS UNION 484 APPROVED.EXISTING Customer 2 Name Review Information Customer 3 Name Review Information Customer 4 Name Review Information Customer 5 Name Review Information Date 02/06/2004 Banking Center Name BROADWAY AND WARREN Si' Associate's Phone Number Associate's Name SHIVANI DURVE 93.14-900934 01,2004 ?Thy( EFTA00123690  - . • EFTA00123691