Form Bbg6185 - Authorization For Information And Certificate Of Authority
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3C L E A R
Authorization for Information
and Certificate of Authority
In connection with a Business Account Application
To help the government fight the funding of terrorism and money laundering activities, U.S. Federal law requires financial institutions to
obtain, verify, and record information that identifies each person (individuals and businesses) who opens an account. What this means
for you: When you open an account, we will ask 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.
Business Account Applicant
Legal Name of Business Entity (Include DBA name if applicable)
Section 1: Authorization for Information in Connection with a Business Account Application
Signature Capture – Owners/Key Individuals with control (i.e., authority or influence) over the entity’s structure, policies, and philosophies
By signing this form, I authorize Wells Fargo Bank, N.A. (“the Bank”) to obtain verifications and reports from time to time, such as credit
bureau reports and account status reports on me as an individual, in connection with the business account application for the above-named
business and any other account applications by this business. I understand the Bank requests this information for legitimate business reasons
including reducing fraudulent accounts and preventing access to financial information and accounts by unauthorized persons. Should the
information obtained from any such report cause the Bank to deny the account application for the business, I also authorize the Bank to
communicate, either explicitly or implicitly, to any co-applicant and to any co-owner, director, officer, or employee of the business that the
denial was based in whole or in part on such information. I also authorize the Bank to use such information and to share it with its affiliates in
order to determine whether the business is qualified for other products and services offered by the Bank and its affiliates.
Print Full Legal Name of Owner/Key Individual
Owner: _____________% of ownership
Position/Title
Phone number
Social Security Number (SSN)
Select One
Signature
Date
Print Full Legal Name of Owner/Key Individual
Owner: _____________% of ownership
Position/Title
Phone number
Social Security Number (SSN)
Select One
Signature
Date
Print Full Legal Name of Owner/Key Individual
Owner: _____________% of ownership
Position/Title
Phone number
Social Security Number (SSN)
Select One
Signature
Date
Print Full Legal Name of Owner/Key Individual
Owner: _____________% of ownership
Position/Title
Phone number
Social Security Number (SSN)
Select One
Signature
Date
BBG6185 (Rev04-03/16)
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Parent category: Business