EFTA Document EFTA01480398

0 < a “ 10 O Z -n ea — CD ci) o M ^. 0 T> co m co co CD co co a a. 64L L LZ00WO- ANGS LSSZ0000-ANOS-INdr a CHEMICAL PERSONAL SIGNATURE CARD TODAY'S DATE ..,1 ACCOUNT TITLE (.1 joint (re si count is nays to either owner, or the survivor). • ec)U 31 7151 1 s i—fr) t inky iv e ii DAA UHT 0 ENED MC NO. 5 ... °Individual orrr °Fiduciary Trust °Tenants In Common °Joint OUGMA °Estate °Custodian 00thm °Checking °Checking with Interest/NOW OMMA OSavings 00ther I (we) agree that I (we) have reviewed the information contained in this Signature Card and the Persona/ Account Application and find it &alum on this date. I (we) have received and agree to the tams and conditions of the Deposit Account Agreement and Disclosures and the Chemical Banking Card Agreement in effea from time to time for the type amount Rue) have selected. In addition, (we) certify that the signateas) presented on this Signature Card will revoke all prior signature(s) for this account. PRI A Al URE JOINT APPLICANT SIGNATURE X X CCOUNT INFORMATION._ DACE OF BIRTH (Pnrnc... A -,•,) OCIAL SECURITY NO. MOTHER'S MAIDEN NAME monilliIIIIIIIIIIII— I I l l 1 1 I I I I I Is this a revised Signature Card for an existing account? 0 Yes No The information on this Signature Card has been verified by: ( fficer's Initials) ENTER ON REVERSE SIDE ALL PERTINENT POWER OF ATT EY AND/OR BENEFICIARY INFORMATION. EFTA01480398