Business Deposit Account Application

Thank you for your interest in First National Bank of Muscatine. Our general trade area is Muscatine County, Iowa and the surrounding contiguous counties. We welcome all applications from our designated market area.

Account being applied for:

Business Checking

Small Business Checking

Small Business NOW (Interest Bearing)*

Non-Profit Organization Checking Business Money Market Business Savings

* Available to Individuals, Sole Proprietorships, Certified Non-Profit Organizations, and Government Agencies.

Check One:

	Corporation - for profit		LLC (Limited Liability Corp.)
	Sole Proprietorship		Partnership
	Joint Venture - Corporation - not for profit		Non-Profit Association
	Other

Name of Business:
          (For Corporations, as shown on Articles of Incorporation)

  Name of Account:
                    (Example: ABC, Inc. Employee's Retirement Trust)

Business Street Address:

City: State: Zip:

Mailing Address:

City: State: Zip:

Business Phone: Fax Phone:

Tax ID Number: Type of Business:

Contact Person: Phone Number:

Email Address:

Personal Information on Each Signer

Name:

Title:

Authorized to Withdraw Funds from this Account? Yes No

Social Security Number:

Driver's License Number or Registered ID:

State

Expiration Date:

Date of Birth:

Mother's Maiden Name:

Name:	Name:
Title:	Title:
Authorized to Withdraw Funds from this Account? Yes No	Authorized to Withdraw Funds from this Account? Yes No
Social Security Number:	Social Security Number:
Driver's License Number or Registered ID:	Driver's License Number or Registered ID:
State	State
Expiration Date:	Expiration Date:
Date of Birth:	Date of Birth:
Mother's Maiden Name:	Mother's Maiden Name:

Name:	Name:
Title:	Title:
Authorized to Withdraw Funds from this Account? Yes No	Authorized to Withdraw Funds from this Account? Yes No
Social Security Number:	Social Security Number:
Driver's License Number or Registered ID:	Driver's License Number or Registered ID:
State	State
Expiration Date:	Expiration Date:
Date of Birth:	Date of Birth:
Mother's Maiden Name:	Mother's Maiden Name:
Facsimile Signature: Yes No Provided: Yes No

I understand that this is an application for an account(s) with First National Bank and is subject to approval. Everything that I have stated in this account agreement is correct to the best of my knowledge. You are authorized to check credit, company history and conduct an inquiry into past banking relationships.

APPLICANT TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION

(Please enter your Social Security Number or other Taxpayer Identification Number)

Certification	Under penalties of perjury, I certify that:
1. The number shown on this form is my 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. Do not check next to item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.
Signature:

Signature(s) — The undersigned agree(s) to the terms stated in this form and acknowledge(s) receipt of a completed copy on today's date.

Applicant Signature:

Date:

Applicant Signature

Date:

Comments:

REMINDER: If you wish to send your application to us online, we want to remind you that e-mail applications are not necessarily secure against interception. Applications, by their nature, include personal and confidential information such as your tax identification number and financial information. Therefore, you may wish to consider printing the application, completing it, and sending it to us via U.S. postal mail.

Once we receive this application we will be in touch with you to follow-up and receive your signature(s).

If you choose to print this application at this time, please select the landscape option in the "Page Setup" function for best viewing.

Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account in order to help the government fight the funding of terrorism and money laundering activities. This means that when you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

Updated 09/03