EFTA00125032.pdf

WELLS Consumer Account Application FARGO Bank Name: Store Name. WELLS FARGO BANK, N . A . BELLEVIEW & KIPLING Banker Name: OfficeriPortfoGo Number: Dater BEEVERS, CHARLES L6623 11/17/2016 Banker Phone: Store Number Banker AU: • 06623 To help the government fight the funding of terrorism and money laundering activities, U.S. Federal tom-quires financial institutions to obtain, verify, and record information that identifies each person (individualsand businesses) who opens an account. What this means for you: When you open an account we will ask too you name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's licenses oche, identifying documents. New Account Information Product Name: Account Number. Product: Wells Fargo Everyday Checking IDDA Purpose of Account. Motor COID. Personal/Household 1163 New Account lGt Chedcing/Savings Bonus Offer Available: I NO Related Customers Customer Name. Account Relawnslup CARLOS PEREZ Sole Owner Statement Mailing Information Customerfs) Listed on Statement Statement Mailing Address: [CARLOS PEREZ Address Line 2. City. State: ZIP:Postal Code. Country. US Page I of 2 D5G6921 (5.16 SW ) 2W02-000865833262-01 Wells Fargo Confidential EFTA00125032  Consumer Account Application Customer 1 Information Customer Name Street Address. CARLOS PEREZ Customer Number a(NJ Address tme 2. Account Relationship: Address Une3: Sole Owner Tawayer Identification Number (TIN): TIN Type: Date ofBirth: City State ISSN • Primary ID Type: Primary ID Description: ZIP/Postal Code: Country. Timeat thisaddress: US 4 Year(s) 10 /Aondris) Directional Address' (Document alien no physical residence, business of alternatestreet address.) 111.1011101.1111111_ Secondary ID type: Secondary ID Description: OTHR EM DEPARTMENT OF JUSTICE Secondary IDStateKountry. Secondary IDIssueDate: Secondary IDExpiration Date: Previous Street Address: CO '03/31/2015 Home Phone Rosiness Phone State Current Employer 2IP/Postal Code. Country 111114: at this address (Butner Prison Yeahs) Months) Check Reporting: CountryWin/en/lip: NO RECORD US Customer Signatures Everything I have stated in this application is correct. You are authorized to make any inquiries that you consider appropriate to determine if you should open or maintain the account. This may include ordering a credit report or other report 0.e. information from any motor vehicle department or other state agency) on me. I have received a copy of the applicable account agreementand the privacy policy (each may be amended from time to time)and agree to be bound by their terms. I also agree to the terms of the dispute resolution program described in the foregoing agreements. Under the dispute resolution program, our disputes will be decided before one or more neutral persons in an arbitration proceeding and not by a jury trial or a trial before a judge. Customer 1 Name CARLOS PEREZ Customer I Signalise Submit manually Date E Signature not required 11/17/2016 Page 2 of 2 DSG8921 (5-16 SW ) 2W02-000865833262-0. Wells Fargo Confidential EFTA00125033