Business Customer Profile Worksheet Page 2
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3Business Customer Profile Worksheet
Critical Notice to New Customers: Federal regulations require all financial institutions to obtain, verify and retain identifying information for each person or
entity that opens an account. Due to these regulations we will ask for the following information and, in addition, upon our discretion, we may ask to see and
copy other identifying documents as part of our review process.
*Completed only for Non-Money Service Businesses – MSBs complete
CM-0006 MSB Application
1. Does the Business intends to or already cater to clients in the Gambling or Pornography Industries?
NO
YES
2. Does the Business intend to or does it already utilize a payment processor or any other non-regulated outside service to
clear negotiable items?
NO
YES
3. Does the Business operate ATM machines at their location(s)?
NO
YES
(Skip to Section 3)
If “YES” - How many ATM machines total does the Business Operate: ____________
4. If “YES” to Question 3, will the Business withdraw cash from MBOC to service ATM machines?
NO
YES
If “NO” - what Bank will the cash be withdrawn from to service each ATM machine? _________________________
If “YES” - how much estimated cash will be withdrawn on a daily basis: ____________________________________
SECTION 3: OTHER BANKING RELATIONSHIPS
Will this be the only account relationship that this Business establishes?
NO
YES
(If NO, please provide a list of each Bank and a written explanation as to what services will/are being utilized at the other Bank(s))
SECTION 4: ESTIMATED TRANSACTION VOLUME RANGE
Total Dollar Volume
Total # of
Transaction Type
Anticipated
Transactions
$
Volume of monthly Check Deposits
$
Cash Deposited Each Month
$
Cash Withdrawn Each Month
$
Total ACH Credits Each Month
$
Total ACH Debits Each Month
$
Outgoing Wire Transfers
$
Incoming Wire Transfers
$
Cashier’s Check Purchases
Signature
By signing below I certify under penalties of perjury that the information provided on this Business Profile Worksheet is
correct and complete.
Printed Name
Title
Signature
Date
NA-0012B (Rev.06/13) PC
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