TXN Bank | Business Customer Identification Form

Business Customer Identification Form

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. By signing this form, you are confirming that all information provided to our financial institution is valid to the best of your knowledge.

Business Name(Required)

(Must Match TIN Docs)

DBA Name (if applicable)

(Must Match Assumed Name Cert)

EIN(Required)

SSN(Required)

(for DBA, Revocable Trusts & QIT’s ONLY)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone Number(Required)

Secondary Phone Number

Email Address(Required)

Website

(if applicable)

Forms Used to Verify Entity

Customer Name

(Business Owner/Person Authorized to Open Account on Behalf of Entity)

Date(Required)

CSR

You will be emailed instructions on how to sign the document once this form is submitted

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