Form Bbg6185 - Authorization For Information And Certificate Of Authority Page 2

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Section 2: Individual owners with 25% or more ownership who do not have authority and control to manage the business

(Note: Sole Proprietors do not complete this section)

Print Full Legal Name of Individual Owner

Social Security Number (SSN)

Position/Title

Select One

Phone number

% of Ownership

Print Full Legal Name of Individual Owner

Social Security Number (SSN)

Position/Title

Select One

Phone number

% of Ownership

Section 3: Non-individual owners with 25% or more ownership

(Note: Sole Proprietors do not complete this section)

Print Full Legal Name of the Non-Individual Owner

Tax Identification Number (TIN) Authority and control

% of Ownership

Phone number



Yes  No

Entity type

Sub-type

Country of Registration State of Registration

Physical Address

Select One

Print Full Legal Name of the Non-Individual Owner

Tax Identification Number (TIN) Authority and control

% of Ownership

Phone number



Yes



Entity type

Sub-type

Country of Registration State of Registration

Physical Address

Select One

Section 4: Certificate of Authority

Each person who signs below certifies that:

A. The use of any Bank deposit account, product or service by the customer of the Bank for which this Certificate of Authority is issued (the “Customer”)

will confirm the Customer’s receipt of, and agreement to be bound by, the Bank’s applicable fee and information schedule and account agreement

that includes the Arbitration Agreement under which any dispute between the Customer and the Bank relating to the Customer’s use of any Bank

deposit account, product or service will be decided in an arbitration proceeding before a neutral arbitrator as described in the Arbitration Agreement

and not by a jury or court trial.

B. Each person who signs at the end of this Section 4, or whose name and specimen signature appear in Section 6, below, is authorized on such terms

as the Bank may require to:

(1) Enter into, modify, terminate and otherwise in any manner act with respect to accounts at the Bank and agreements with the Bank or its affiliates

for accounts and/or services offered by the Bank or its affiliates (other than letters of credit or loan agreements);

(2) Authorize (by signing or otherwise) the payment of Items from the Customer’s account(s) listed on this Authorization for Information and

Certificate of Authority or from accounts that the customer opens after the date of this Authorization for Information and Certificate of Authority

(including without limitation any Item payable to (a) the individual order of the person who authorized the Item or (b) the Bank or any other

person for the benefit of the person who authorized the Item) and the endorsement of Deposited Items for deposit, cashing or collection

(see the Bank’s applicable account agreement for the definitions of “Item” and “Deposited Item”);

(3) Give instructions to the Bank in writing (whether the instructions include the manual signature or a signature that purports to be the

facsimile or other mechanical signature including a stamp of an Authorized Signer as the Customer’s authorized signature without regard to when

or by whom or by what means or in what ink color the signature may have been made or affixed), orally, by telephone or by any electronic means

in regard to any Item and the transaction of any business relating to the Customer’s account(s), agreements or services, and the Customer shall

indemnify and hold the Bank harmless for acting in accordance with such instructions; and

(4) Delegate the person’s authority to another person(s) or revoke such delegation, in a separate signed writing delivered to the Bank.

C. If a code must be communicated to the Bank in order to authorize an Item, and the code is communicated, the Item will be binding on the Customer

regardless of who communicated the code.

D. Each transaction described in this Certificate conducted by or on behalf of the Customer prior to delivery of this Certificate is in all respects ratified.

E. If the Customer is a tribal government or tribal government agency, the Customer waives sovereign immunity from suit with respect to the

Customer’s use of any Bank account, product or service referred to in this Certificate.

F. The information provided in the Customer’s business account application is correct and complete, each person who signs at the end of this Section 4 and

each person whose name appears in Section 6, below, holds any position indicated, and the signature appearing opposite the person’s name is authentic.

G. The Customer has approved this Certificate or granted each person who signs at the end of this Section 4 the authority to do so on the Customer’s behalf by:

(1) resolution, agreement or other legally sufficient action of the governing body of the Customer, if the Customer is not a trust or a sole proprietor;

(2) the signature of each of the Customer’s trustee(s), if the Customer is a trust; or

(3) the signature of the Customer, if the Customer is a sole proprietor.

Required Signature(s): At least one individual owner, partner, or key executive with authority and control over the business must sign.

For jointly owned sole proprietorships, both owners must sign.

Signature

Print Full Legal Name

Title/Position

Date

Signature

Print Full Legal Name

Title/Position

Date