River City Bank Deposit Account Agreements - 2016

EFIN

Date

2016 RIVER CITY BANK DEPOSIT ACCOUNT AGREEMENTS

DEPOSIT ACCOUNT/FEDERAL ELECTRONIC REFUND CHECK (FEDERAL ERC) AGREEMENT, AND (IF SO DESIGNATED) FEDERAL REFUND

ELECTRONIC TRANSFER (FEDERAL RET) AGREEMENT, AND (IF APPLICABLE) STATE ELECTRONIC REFUND CHECK (STATE ERC) AGREEMENT, AND

(IF APPLICABLE) STATE REFUND ELECTRONIC TRANSFER (STATE RET) AGREEMENT, AND (IF APPLICABLE) ADVANCE REFUND FEATURE

(FREEDOM750) AGREEMENT WITH RIVER CITY BANK, INC. (AND ITS SUCCESSORS AND/OR ASSIGNS). THIS IS AN AGREEMENT FOR A FEDERAL ERC

OR RET FROM THE BANK. THIS MAY ALSO BE AN AGREEMENT FOR A STATE ERC/RET.

Where used in this "Agreement" the terms "I," "my," “we,” and “our(s)” mean the applicant applying for a deposit account. The term "Bank" refers to River City Bank, Inc.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify, and record information that

identifies each person who opens an account. What this means for you: When you open an account, we will ask you for your name, address, date of birth, and other information that will

allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

I certify that I have reviewed my personal information above and that it is true and accurate. I hereby agree and understand that by way of my signature below I am authorizing the

Bank to establish a special single-use deposit account in my/our name(s) (“Deposit Account”) at the Bank to receive our 2015 Federal Income Tax Refund (“Federal Refund”) from the

Internal Revenue Service (“IRS”) and my 2015 State Income Tax Refund (“State Refund”), if applicable, in the Total Anticipated Federal Refund amount and in the Total Anticipated

State Refund amount, if applicable, listed on this page, or such other amount as the IRS shall determine to be our Federal Refund or such other amount as the State Treasury shall

determine to be our State Refund (“Direct Deposit”).

I certify that I have received the RIVER CITY BANK DISCLOSURE BOOKLET containing all applicable disclosures regarding my Electronic Refund Check or Refund Electronic

Transfer, and (if applicable) State Electronic Refund Check or State Refund Electronic Transfer.

By signing this page, I/we authorize the Bank to establish a special use deposit account in my/our name for the purpose of receiving a direct deposit of my/our federal tax refund from

the Internal Revenue Service as designated on Form 8879 or 8453 and/or my/our state tax refund. A Federal ERC or RET must be applied for in order to apply for a State ERC/RET

I/We acknowledge that the ERO/TRANSMITTER has served as my/our agent in the completion and transmission of the Application(s) to the Bank and I/we fully understand that the

ERO/TRANSMITTER is an independent contractor and has no authority whatsoever, from the Bank or otherwise, to approve a Federal ERC or RET Application or State ERC/RET

Application or to otherwise negotiate the terms thereof. By signing this agreement, I/we hereby certify that I/we have read, understand and agree to all of the terms and

provisions set forth in the RIVER CITY BANK DISCLOSURE BOOKLET, including the disclosures set forth above and herein, and including the Arbitration Provision.

SEE ABOVE AND ALL PAGES OF THE RIVER CITY BANK DISCLOSURE BOOKLET FOR ADDITIONAL TERMS WHICH ARE INCORPORATED HEREIN BY

THIS REFERENCE ABOVE THE SIGNATURE LINES. ACCEPTANCE OF THE APPLICATION(S) DOES NOT CONSTITUTE APPROVAL.

THE APPLICANT MUST NOT SIGN THIS AGREEMENT IF HE/SHE HAS NOT RECEIVED THE RIVER CITY BANK DISCLOSURE BOOKLET. IF A DISCLOSURE

BOOKLET IS NOT PROVIDED, RIVER CITY BANK SHOULD BE CONTACTED AT (888) 820-7848. THE APPLICANT MUST ALSO VERIFY THE IDENTIFYING

INFORMATION ABOVE BEFORE SIGNING THIS AGREEMENT.

ESTIMATION OF FEDERAL ERC/RET NET PROCEEDS

ESTIMATION OF STATE ERC/RET NET PROCEEDS (if applicable)

TOTAL ANTICIPATED FEDERAL REFUND AMOUNT………..…...$_________

TOTAL ANTICIPATED STATE REFUND AMOUNT……….……...$_________

Less FREEDOM750 ............................................................ ………..$________

Less TOTAL DEPOSIT ACCOUNT CHARGES…………....……..$_________

Less TOTAL DEPOSIT ACCOUNT CHARGES................... ………. $_________

Less Direct2Cash FEE…………………………………………...…..$_________

Less TAX PREPARER FEES ................................................. ………. $_________

TOTAL FEES AND CHARGES PAID BY TAXPAYER….….......$_________

Less ELECTRONIC PREP FEES…………………………………….. $_________

ESTIMATED STATE ERC/RET PROCEEDS…………………....$_________

Less ELECTRONIC FILING FEE 1....................................... ………. $_________

Less ELECTRONIC FILING FEE 2....................................... ………. $_________

Less ELECTRONIC FILING FEE 3……………………..………..…..$_________

Less Direct2Cash FEE……………………………………………..…...$_________

TOTAL FEES AND CHARGES PAID BY TAXPAYER………...…$_________

ESTIMATED FEDERAL ERC/RET PROCEEDS .............. ………..$_________

***ADVANCE COLLECTION AUTHORIZATION***

I/we understand, acknowledge and agree that if I/we elect to participate in Freedom750, such election will not constitute River City Bank’s approval of me/us as (a) Freedom750

candidate(s) nor shall such election constitute an agreement by River City Bank to provide me/us with an advance. I/we understand, acknowledge and agree that (i) River City Bank

may approve or deny advances subject to its internal qualification and eligibility criteria in its sole discretion, and (ii) if approved as (a) Freedom750 candidate(s), I/we will receive a

tax refund advance of $750.00. I/we further understand and acknowledge that the advance received under Freedom750 shall not constitute a loan, and I/we hereby acknowledge that

I/we have been informed that Freedom750 is optional and is not a requirement of obtaining an ERC/RET. If I/we have elected to participate in Freedom750, I/we authorize and instruct

River City Bank to deduct from the proceeds of my/our Federal ERC/RET or State ERC/RET, an amount equal to the $750 advance I/we previously received from River City Bank and

to pay such amount to River City Bank, as repayment of such advance amount.

I/we understand and agree that the Bank will deduct and disburse to the appropriate recipients thereof, and is HEREBY AUTHORIZED TO DEDUCT AND DISBURSE, THE

ABOVE FEES AND CHARGES FROM THE PROCEEDS OF MY/OUR FEDERAL ERC/RET, STATE ERC/RET, AND/OR OVERAGE CHECK(S), as designated above

and in accordance with the terms contained herein and in the RIVER CITY BANK DISCLOSURE BOOKLET.

In addition, in the event that I/we have applied for a State ERC/RET along with either a Federal ERC/RET and the IRS, for whatever reason, fails to deposit my/our Federal Refund into

my/our Deposit Account, I/we understand, agree and authorize the Bank to deduct from the proceeds of my/our State Refund and disburse to the appropriate recipients thereof, any and

all of the fees associated with and/or related to the State ERC/RET and/or Federal ERC/RET.

Applicant Signature

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Joint Applicant Signature

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ERO/TRANSMITTER or Preparer Signature certifying verification of Applicant’s IDs and Joint Applicant’s IDs

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Revised September 23, 2015