1 Contact Info 2 Legal Entity Information 3 Individual Opening Account / Signer 4 Account Information 5 Certification of Beneficial Owner(s) 6 Beneficial Owner Identity Verification 7 Privacy Policy How can we contact you? Let's start with a little information about you. First Name * Required Middle Name Required Last Name * Required Email Address * Required Confirm Email Address * Required Address Line 1 * Required Address Line 2 City * Required State * Required Please select a state Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Northern Mariana Islands Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington U.S. Virgin Islands West Virginia Wisconsin Wyoming Zip * Required Date of Birth *Invalid Date Social Security Number *Required Phone Number *Required Legal Entity Information Please answer all questions. Legal Entity Name * Required Legal Entity Type * Required Nature of Business * Required Use ofAaccount (Money Services) * Required Select Yes No Use of Account (Marijuana Business) * Required Select Yes No Wire (Approx. Monthly Amount) * Required $ Use of Account (ATM) * Required Select Yes No Street Address (PO Box holders must list physical address and mailing address) * Required City * Required State (ex. MN) * Required Zip Code * Required Tax ID Number * Required Work Phone Number * Required Individual Opening Account / Signer Please answer all questions. First Name * Required Middle Initial * Required Last Name * Required Position / Title * Required Street Address (PO Box holders must list physical address and mailing address) * Required City * Required State (ex. MN) * Required Zip Code * Required Phone Number * Required Email address Required Driver's License Number (Or other photo ID identifying number) * Required Issuing State (ex. MN) * Required Expiration Date * Required Account Information Please answer all questions that apply to you. Type of Account * Required Select Business Checking Business Money Market Amount of Opening Deposit * Required $ Source of Funds * Required Select Check Internal Transfer Cash Account Number (if applicable) Required Completion date of this form * Required Certification of Beneficial Owner(s) Please answer all questions. Name and Title of Natural Person opening account * Required Account Number Required Name & Type of Legal Entity * Required Address of Legal Entity * Required Name of individual #1 that owns 25% or more of equity interests of Legal Entity listed Required Date of Birth of individual #1 Required Address of individual #1 Required Individual #1 Social Security Number (ex. ###-##-####) Required Individual #1 For Non-U.S. Persons: SSN, Passport Number, and country of issuance Required Individual #1 percentage of ownership Required Name of individual #2 that owns 25% or more of equity interests of Legal Entity listed Required Date of Birth of individual #2 Required Address of individual #2 Required Individual #2 Social Security Number (ex. ###-##-####) Required Individual #2 For Non-U.S. Persons: SSN, Passport Number, and country of issuance Required Individual #2 percentage of ownership Required Name of individual #3 that owns 25% or more of equity interests of Legal Entity listed Required Date of Birth of individual #3 Required Address of individual #3 Required Individual #3 Social Security Number (ex. ###-##-####) Required Individual #3 For Non-U.S. Persons: SSN, Passport Number, and country of issuance Required Individual #3 percentage of ownership Required Name of individual #4 that owns 25% or more of equity interests of Legal Entity listed Required Date of Birth of individual #4 Required Address of individual #4 Required Individual #4 Social Security Number (ex. ###-##-####) Required Individual #4 For Non-U.S. Persons: SSN, Passport Number, and country of issuance Required Individual #4 For Non-U.S. Persons: SSN, Passport Number, and country of issuance Required If no individual meets this definition please enter Not Applicable and explain here Required If applicable explain any layers of Beneficial Ownership Required Name/Title of individual with significant responsibility for managing Legal Entity listed above * Required Date of Birth of individual listed * Required Address of individual listed * Required SSN of individual listed Required For Non-U.S. Persons: SSN, Passport Number, and country of issuance of individual listed Required Name of Natural Person opening account * Required Completion date of this form * Required Beneficial Owner Identity Verification Please answer all applicable questions. Beneficial Owner #1 Full Name Required Beneficial Owner #1 Driver's License Number Required Beneficial Owner #1 State of Issue Required Beneficial Owner #1 Issue Date Required Beneficial Owner #1 Expiration Date Required Beneficial Owner #2 Full Name Required Beneficial Owner #2 Driver's License Number Required Beneficial Owner #2 State of Issue Required Beneficial Owner #2 Issue Date Required Beneficial Owner #2 Expiration Date Required Beneficial Owner #3 Full Name Required Beneficial Owner #3 Driver's License Number Required Beneficial Owner #3 State of Issue Required Beneficial Owner #3 Issue Date Required Beneficial Owner #3 Expiration Date Required Beneficial Owner #4 Full Name Required Beneficial Owner #4 Driver's License Number Required Beneficial Owner #4 State of Issue Required Beneficial Owner #4 Issue Date Required Beneficial Owner #4 Expiration Date Required Individual with Control Full Name Required Individual with Control Driver's License Number Required Individual with Control State of Issue Required Individual with Control Issue Date Required Individual with Control Expiration Date Required Privacy Policy Please read and accept the privacy policy to continue. Accept Privacy Policy You're done! Thank you for completing your application! You can now begin signing your closing documents. Thank you for completing your application!Your financial institution is reviewing your application and will contact you for the next steps.You can now safely close your browser window or tab. Thank you for your submission! Your financial institution will contact you for the next steps.You can now safely close your browser window or tab. © Copyright 2024 Epic River Financial, Inc. All rights reserved. Version 23.4.3.17