EFTA00123687.pdf

Auq, 08-2012 08.12 AM BANK OF AMERICA 9/19 Personal Signature Card (TILE "BANK") with Substitute Form W-9 14:ideS d Account Number Account Type MYACCESS CHECKING Acount Title Tetr.porary Signature Card (deposit accounts only) By signing below, Uwe acknowledge and agree that this account is and shall be governed by the tams and conditions set forth in the following documents. as corroded from time to time (I) if this account is a deposit account, the Deposit Agreement and Disclosures, the Personal Schedule of Fees and the Miscellaneous Fccs for Personal Accounts. and (2) if this account Is a Lino of Credit, the Line of Credit Agreement and Disclosures. Furthermore, I/we acknowledge the receipt of these documents. A joint account is the property of each co-owner as joint tenants with right of survivorship and payable to either co-owner or to the surviving co-owner(s) if a co-owner dies. By signing below, that also aecnowledge and agree that the signatures) will servo as verification for any transaction in connection with this account, any Line of Credit checks which Uwe may sip, and as the certification (set forth below) of the taxpayer identification number to which Uwe want interest reported. Substitute Form W-9. (Required only for Deposit Accounts) Certification- Under penalties of perjury, I certify that: The number shown on this form Is the correct taxpayer identification number (or I am waiting for a number to be issued to me), and (2) 1 am not *object 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 t am subject to backup withholding as a result of a (allure to report all interest or dividends, or (C) The IRS has notified me that I am no longer subject to backup withholding, and (3) I am a U.S. chime or other U.S. person (as defined in the Instructions). Certification Instructions You must cross out item (2) above if you have boon notified by the IRS that you are contently subject to backup withholding because of underreporting interest or dividends on your tax return. (See also IRS instructions for Form W-9). The Internal Revenue Service does not require your consent to any provision of this document other than the terrific a Inn t required to avoid backup withholding. Report Tax Identification Number Interest On 2. 3. 4. 5. 0 K K K • By elwaing the box marked "ATMCbcck Card Reepestedr. Uwe/hereby meat in Automatic Teller Mecham Card angler a Cheek Cat By signing below, I Daman a the issue of an ATM Card andhar Check Card to the otha naafi holders iodated above • Fa Masstchosetts only -By checking the box nuked "AlMitheck Card Rego:sit:dr, I hereby request an ATM Cud anewCho:lc Card. By signing this Signore Card. I oaten bathe Issuance of an ATM Card ordlor Check Card to any of the account holden of *iv OCC0411.1. Rank Information Caste Review Customer 2 Name ATM/Cheek Card Requested ? • (Deposit Accounts Only) K 0 Review Information Cutomer 3 Name Review Information Customer 4 Name Review Information Customer 5 Name Review information Date 48/07/2012 Banking Center Name PELHAM PARKWAY Associate's Name Associate's Phone Number NNY 9$-14-9009M 10.2009 EFTA00123687