Bank of America. Personal Signature Card with Subst Form W-9 Account Number —_— O Temporary Signature Card (deposit accounts only) Account Type Account Title —Ee By signing below, l'we acknowledge and agree that this account is and shal] be governed by the terms and conditions set forth in the following documents, as amended from time to time: (1) if this account is a deposit account, the Deposit Agreement and Disclosures, the Personal Schedule of Fees and the Miscellaneous Fees for Personal Accounts, and (2) if this account is a Line of Credit, the Line of Credit Agreement and Disclosures. Furthermore, I/we acknowledge the receipt of these documents, A joint account Is the peorty of each co-owner as joint tenants with right of survivorship and payablo to either co-owner or to the surviving co-ownor(s) if a co-ownor dios. By signing below, L/we also acknowledge and agree that the signature(s) will serve as verification for any transaction in connection with this account, any Line of Credit checks which I/we may sign, and as the certification (set forth below) of the taxpayer identification number to which I/we want interest reported. Substitute Form W-9. (Required only for Deposit Accounts) Certification- Under alties of perjury, | certify that: 1) The numbor shown on this form is correct taxpayer iden number (or | am waiting for a number to 0 issued te mo), and (2) | am not subjoct to backup withholding because: (A) 1 am oxompt from backup withholding, or (B) | have not been notified by the Internal Revenue Service (IRS) that | am subject to backup withholding as a result of a failure to report all intorest or dividends, or (C) IRS has notified me that | am no longor sub te backup withholding, and (3) 1 am a U.S. porson { g a U.S. resident alien). in Instructions You must cross out item (2) above if you have been notified by the IRS that you are currently 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 certifications required to avo|d ckup withholding. Report ATM/Chock Card Interest Fa Roquested ? * Tax ber On (Deposit Accounts Only) 2. 0 O 3 0 Oo 4. Oo ee O 5. oO O * By checking the box marked "“ATM/Check Card Requested?", Uweshereby request an Automatic Teller Machine Card and/or a Check Card. By signing below, I consent to the issue of an ATM Card and/or Check Card to the other account holders indicated above. *For Massachusetts only - By checking the box marked "ATM/Check Card Requested?", I hereby request an ATM Card and/or Check Card. By signing this Signature Card, | consent to the issuance of an ATM Card and/or Check Card to any of the account holders of this account. Bank Information Customer 1 Name SY US DRIVER PERMIT W/PHOTO Review Information TRANS UNION 484 APPROVED.EXISTING F Customer 2 Name Review Information Customer 3 Name Review Information Customer 4 Name Review Information Customer 5 Name Review Information Date 02082009 == Banking Center Name ___BROADWAY AND WARREN Associate's Phone Nunbe: i — Associate's Name —_ SHIVANI DURVE. 95-149008M 022006 wry EFTA00123690

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