90 Day Demand Note
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190 Day Demand Note
Southern Union Revolving Fund, INC.
PO Box 923868, Norcross, GA 30010-3868
Ph. 770-408-1800 Fax 770-408-1801
Conference/Organization: _______________________________________________________________________________
Local Church:
______________________________________________________________________
(for personal accounts only)
Address: ______________________________________________________________________________________________
Email: ________________________________________________________________________________________________
Phone: _______________________________________ Fax: ___________________________________________________
Please complete form and submit to your local Conference office.
__ 00 __ __ __ __ __ Revocable Trust with Conference/Union as Trustee (Conference will obtain EIN)
__ 01 __ __ __ __ __ Non-trust Demand Note
__ 02 __ __ __ __ __ Church, School, or Conference Entity
__ 03 __ __ __ __ __ Self-administered Revocable Trust (attach copy of Certificate of Trust)
Date: ____________________
$1,000 minimum required to open an account.
(For personal accounts there is the option to
send the check directly to SURF.)
Name: ______________________________________________________ SSN or EIN: _______________________________
Second Name: ______________________________________________ SSN : ___________________________________
Address: ___________________________________________________ County: _________________________________
City: ____________________________________
State: ________
Zip: ____________
Phone: ________________
The interest will change when there is a significant fluctuation in the money market in general.
Check one:
Interest accrue OR
If the account balance is greater than $10,000, interest will be paid quarterly
Certification:
Under penalties of perjury, I/we certify that:
1.
The number(s) shown on this form is/are my correct taxpayer identification number(s); AND
2.
I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the
Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or divide
3.
I am a US person (including a US resident alien).
Signature: ____________________________________________________________
Date: ___________________
Signature: ____________________________________________________________
Date: ____________________
Non-trust demand note beneficiary designation:
Pay on death to:
Name: ________________________________________________________________________________ % ___________
Phone: ______________________
Email: ____________________________________________ SSN: ____________
Name: ________________________________________________________________________________ % ___________
Phone: ______________________ Email: ____________________________________________
SSN: ____________
Church Membership Verified by: __________________________________________________________________________
Conference Representative
Revised 11-12-2013
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Parent category: Miscellaneous