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DATE: |
Deposit Account Application Information
(Use to apply for a Business, Professional, or Organizational Account)
An Authorized Signer from the business is required to provide the proper
documentation and to sign the necessary documents to open a Business Account.
|
Applying for (ü) |
Checking | Money Market |
| Savings | Certificate of Deposit |
What Type of Entity of is Your Business?
(If Non Profit Organization is selected please select from the list below)
Business Name:
Street Address 1: Street Address 2:
(Note: PO Box holders must furnish physical address as well as mailing address)
City: State: Work Phone: --
Nature of Business (be specific, e.g. (Store – Furniture? Auto Parts? Convenience?):
· Do you cash checks for your employees or customers by giving them cash back? Yes* No
IF YES, what percentage of your deposits will be made up of these checks?
Minimal 25% 50% 75%
· Do you or will you have an ATM on your premises? Yes* No (*If YES, Send Copy of this Application to Compliance)
Additional Products or Services Requested
| Business Check Card (application needed) | Telephone Banking | Combined Statement |
| Cash Management Services | Electronic Bill Pay (application needed) | Overdraft Protection |
| Remote Deposit Capture | Loan Products or Services | Merchant Credit/Debit Card Services |
| E-Mail Statements | Internet Banking (application needed) |
X__________________________________________________
Authorized Signer
Required Documentation - Bring these items to the bank when you come in to sign the new account documents.
Organizational Document
(For example, Articles of Incorporation (for corporations), or Organization (for LLCs),
or Association (for unincorporated organizations), Partnership Agreement, Business License for
a Sole Proprietorship, Assumed Name Certificate, if “doing business as,” etc.)
Certification of Taxpayer Identification Number or Employer Identification Number
Properly executed resolution with the following:
(a) Providence Bank named as depository,
(b) authorized individuals named to open or change signer(s) for account(s), and
(c) authorized parties named and their authority to sign checks and to do other banking functions identified.
Copies of Driver’s License or other government issued identification for each authorized party
| Estimated Weekly Deposits | Estimated Weekly Debits/Withdrawals |
| $ | $ |
| $Checks | $Checks |
| $ACH | $ACH |
| $Wires | $Wires |
| $ | $ |
Print, Sign and Fax to 1-708-589-2913
For security reasons we do not recommended e-mailing this document.
Which branch will you mainly do business with (check only one)?
South HollandDyerMunsterElmhurstSchererville
If you are establishing an account with more than two signers, click here to complete an addendum to add more signers.
