Case File
efta-01281685DOJ Data Set 10OtherEFTA01281685
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01281685
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
SIGNATURE CARD
FIFTH THIRD BANK
(HEREAFTER RFERRED TO AS 'SAM')
Name (Primary Owner)
Shocker Holdings LLC
Account No.
Street Address
27 High Tech Blvd
Type
Business Standard Checking
City and Stele
Thomasville NC
ZIP
27380
Home Phone
Dale of Birth
Mothers Malden Name
Employer
Work Phone
Tax ID or S.S. Number
20-2030353
NEW []ADD
M. REPL
Ownership'
Partnership
Opened By
P Fintchre
BC No.
47349
Date
09124/2013
' Joint accounts shall be owned es joint tenants with right of survivorship, no as tenancy by the entireties
Check appropriate box for federal tax classification
O
lndividuallSole Proprietor
M Trust/Estate
0 Partnership
LLC - Enter tax classification (CeC Corporation, SINS Corporation,
required)
P•Pannership)
S
• C Corporation
OS Corporation
• Outer
0 Non Res.deril Nan
THE UNDERSIGNED AGREES TO THE TERMS AND CONDITIONS AT THE RIGHT
Tee:
Sig.tri)3
I
RIO
Non-US
Senior Foreign
Shocker Holdings Ile
1
Person'
Official"
18,nUTeelays y''''
..;
Yes
'
X
e.:-
, a.--
K
No
M
Yes
No
K a
I Rarpona Fylckers l 1
Yee
No
Yes
No
X
'
. It
ion- ‘iiierL
—
Yes
No
Yes
No
I
Yea
No
Yes
No
X
Payable on Death Beneficiary
$tatement Address
USA PATRIOT ACT REQUIREMENTS:
'I. Ne you a Non-US person with more than S500,000 on deposit or invested with Fifth Thlro7
"2. Ne you a Senior Foreign Official of a government branch, military branch. political party,
foreign government-owned company, or a close personal or professional assodalo of cr.e of these?
96.213 (5/3-REV 6+14)
Send original to Chadic Processing 1M0C11..
CONFIDENTIAL
TERMS AND CONDITIONS
1.
The terms and conditions stated
herein, together w?.n re:mit/lions or
authonzalions which accompany this
signature card. it app'icab'e and the
Ril.cs Regulations. Agreements. an/
Disclosures of Bank constitute the
Deposit
Agreement
(-Agreement')
between the individual (s) or entity (io)
named hereon (*Depositor) and the
Bank.
2. This Agreement Incorporates the
Rules. Regutadons, Agreements, and
Disclosures established by Bank from
time to Into, clearing house roles and
regulations state nna federal lawn,
recognized banking practices and
customs, soma charges as may be
established from lime to time end is
sub;cct to lava regulating transfers at
death and other taxes.
3 fel signers hereby agree that the
above named Dank is authorized to ac
as a depository under Mu terms and
condemns of the Agreement.
4. Bank is authorized to recognize tho
signatures executed hereon in such
numbers as indicated, for the withdrawal
of funds or transactions of any other
business regaming leis account
written notate the contrary Is received
by Bank
a In tho case of overdraft or
Ouarodymont on this account, whether
by error, mistake, Inadvertence or
otherwise, the amount of sett overdraft
or overpayment shall be trr.mcdfatety
paid to Bank
6. Depositor acknowledges and egrets
that Bank. to' itself and as agent fcr
any offilate of Fifth Ted Bancorp, is
granted a security Interest In, and may,
at any time, set off, against any ba'ance
in this account. any debt owed to Bank
by any person having the right of
withdrawal or any debt owed to Bank by
any entity !Med under the Account Talc
A debt Includes. but Is not limited te, on
obligation owing to Bank, whether now
exigible or hereafter acrpired cy Bank
whenever payable end witho.it regard
to whether arsine as maker, drawer,
endorse:, or guarantor.
7 Al. signers agree to the Torms
and Condemns set forth hereon and
acknowledge receipt o' a copy of the
Rules and Regulations, Agreomonki.
and Disclosures of Bank and agree to
the terms sot hnth them n
Verification — interne: Use Only.
I.D.
Run Cdstorner in Quat4ile
Verify Opening behest:
Rag CC Kola (If Needed)
Verify Phone Numbers
Verify Morass
Thank You CardiFollow Up
SDNY_GM_00036248
EFTA_00 14686 I
EFTA01281685
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