Bank Account Dual Name Declaration Form
Use this form to declare that a bank account is jointly held or used under two names. Please complete all relevant sections below.
Primary Account Holder Name
*
First Name
Last Name
Secondary Account Holder Name
*
First Name
Last Name
Primary Account Holder Email
*
example@example.com
Secondary Account Holder Email
*
example@example.com
Primary Account Holder Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Account Holder Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Bank Name
*
Bank Branch Name or Location
Purpose of Declaration (optional)
Submit Declaration
Should be Empty: