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efta-01281685DOJ Data Set 10Other

EFTA01281685

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Unknown
Source
DOJ Data Set 10
Reference
efta-01281685
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EFTA Disclosure
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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