Business Details and Banking Form

Business Details and Banking Form
Business Name
Business Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Business Registration Number
Bank Name
Branch Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Account Holder Name
First NameLast Name
Business Account Number
Routing Number
SWIFT/BIC Code (if applicable)
Business Tax Identification Number (TIN)
List of Authorized Signatories
Full Name Position
Signatory 1
Signatory 2
Legal Structure of the Business
Sole ProprietorshipPartnershipLimited Liability Company (LLC)CorporationOther
Briefly describe the primary activities of the business
Expected Transaction Volumes
LowModerateHigh
Business Account Purpose
General Operating AccountPayroll AccountSavings AccountOther
Declaration:
I hereby declare that the information provided in this form is true and accurate to the best of my knowledge. I understand that providing false information may result in legal consequences.
Signature
Clear
Date Signed
MonthDayYear
Date
Should be Empty:

	Full Name	Position
Signatory 1
Signatory 2