(Page 1 of 1) 1) Bank REGION: Central/Coastal Jersey (14) DATE OPENED: 08/05/2013 NEW PERSONAL ACCOUNT STORE NUMBER: TYPE OF ACCOUNT: TD Simple Checking ACCOUNT TITLING / MAILING ADDRESS; OPENED BY: Marcela Meadows ACCOUNT NUMBER: TYPE Cope: 622 ACCOUNT RELATIONSHIP: Individual — 2 usa CUSTOMER #1 Le MC custowers2 o™ Ta TYPE TN vee [DATE OF BIRTH HOME PHONE Dare OF einer HOME PHONE Primary DENTIFICATION (Desctbe tetow) IDENTIFICATION Descabe betow) in tyre at State Drivers License wiPhoto and Sianat Stipe es WTpees © Typeae Beer my ul beve ne sane LouWwy Of ssuance sterLouwy of Savarce ‘Supe/Country of bearer: Nunter Number Number Sumer Expraton Date Expeation Owe Espaamen Oute Expwation Date VERIFICATION LGA ADD (Nn PO Renes) VERIICATON - 4 SSGNATURE ~ DATE CUSTOMER #2 EMAL _ oo CUSTOMER #4 TH TW TYPE Tw TYPE DATE OF BRT OME Prone DATE OF BRTH HOME PRONE IDENTIFICATION Describe betow) DENTIFICATION [Descrine betow) © Tyee 1 Type az (Tye mt WO Type az ‘Sane/County of swance ‘Se Courtry of Issuance: ‘SatoCourtry of Issuance ‘Sate Courty of ewarce Number Nureer Nurter Nornher Cxpration Oar: Expeston Date, Exprater Date Exprasen Date LECAL ADDMEBS (Me MO Boren) VERIICATION LEGAL ADORE SS (No PO Boxes: VERIFICATION \ \ SIGNATURE OaTE ‘SGNATURE oarTe CUSTOMER 8] EMAL CUSTOMER 4 EM 94004 IMPORTANT INFORMATION Federal law requires ali financial institutions to obtain, verity and record information that identifies each person who opens an account. WWe acknowledge receipt of the Deposit Account Agreement, Account Maintenance Information grid, Fee Schedule and Rates, whch govern mylour accounts wen the Bank. Mylour use of this account sha evidence Mmylour acceptance of Ihe terms and conditions set forth in the Deposit Accourt Agreement, Account Maintenance Information grid. Fee Schedule and any Adgendums as the same may be amended trom ume to time. Joint accounts Bre Owned 8S JOM! Ienants with night of survioeship. WWe, both individually and on behalf of the sccourt owner. if different. hereby authorize the Bank 10. {rom time to lime, request consumer reporis containing reterences about malus trom ihrd parties, such as 9 Consumer reporting agency, in connection with opening and maintaining this account. ¥ you (the Bark) are unable to open a deposit account, you wit provide melus win an additional nolice regarding the consumer reporting agency. By sigring this signature card, we acknowledge that the Genosit account tn which Uwe amlare heing ariiad aa a eranwear may have an evicting Memeyiine account attached. | understand that a Moneyine sccount ‘5 & line of credit for averdraft protection. VWe acknowledge receiot of the Moneviine Aareement and disclosures and agree to their terms and conditions. Wie understand and agree thal as a creamer of the denesit account, Vwe wil be fully responsible for payments an the Moneyline account (mcuding any outstanding balances al this time) and tat payment history and other credit information may be reported to consumer feporing agencies This section Goes not apply lo U.S. non-resident alens. Under penalty of pedury. each customer soning above certiies that 1. The pumber shown on this form is my comect taxpayer identiicaton number (or | am wailing for # number to be issued to me), and 2. Ian not subject to backup withholding because: (3) | am exempt from backup withholding, or (>) | have not been notified by the Internal Revenue Service (IRS) that | am sub) Of a failure to report all erest or dradends. or (c) te IRS has notified me that | am no longer subject to backup wilhholding, and 3. lama US. person Onchuding a US. resident aben) 4 B\YS) withholding as @ result Cortification Instructions. You must eross cut Ram 2 above 4 you have been noted by the IRS that yuu are Garvey subjerd by becky willibukang because you have feied 19 De ang amgencs on your tax return or for ary clher reason. For real estate transactions, ern 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancelistoh of debt, contributions to an individual retirement arrangement (IRA) and. genersily. payments other than intarest and dradends. you see mol required 10 Sign the Certification, bul you enust prowde your correct TIN. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withhotding. Rev 070011 | TO Rank NA aL. instructions for Store Tearn Members: if taxing to CiF. please insert in this direction J. EFTA00124911