WELLS Consumer Account Application FARGO Bank Name Store Name: WELLS FARGO BANK, N.A. BEL Banker Name BE »RS, CHARLES Banker Phone Store Number Banker AU: nker MAC To help the government fight the funding of terrorism and money laundering activities, U.S. Federal law requires financial institutions to obtain, verify, and record information that identifies each person (individuals and businesses) who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. New Account Information Product Name: Account Number Product Wells Fargo Everyday | DDA Purpose of Account Minor COND: sonal/Household 163 New Account Kit: Checking/Savings Bonus Offer Available NO Related Customers Customer Name: Account Relationship. CARLOS PEREZ Sole Owner Statement Mailing Information Customer(s) Listed on Staternent Statement Mailing Address CARLOS PEREZ a Address Line 2 Gity State: ZIP/Postal Code. Country | | HAIN lof2 DSG8921 (5-16 SVP) 2W02 Wells Fargo Confidential EFTA00125032

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Consumer Account Application Customer 1 Information Customer Name Street Address Customer Number (ECN) Address Line 2 Account Relationship: Address Line 3 le 1er Taxpayer Identification Number (TIN): TIN Type: Date of Birth City State Primary ID Type: Primary ID Description: ZIP/Postal Code: Country Time at this address: F | rr Fs US 4 Year(s) 10 Month(s) . . Directional Address (Document when no physical residence, business or alternate street address.) Secondary ID Type: Secondary ID Description OTHR 1 DEPARTMENT OF STICE Secondary ID State/County: Secondary ID Issue Date Secondary ID Expiration Date: | previous Street Address: co 0 1/2018 Home Phone: Business Phone: Gty State Current Employer ZIP/Postal Code: Country: Time at this address Butner Prison Year(s) Month(s) Check Reporting Country of Citizenship: NO R 2D US Customer Signatures Everything | have stated in this application is correct. You are authorized to make any inquiries that you consider appropriate to determine if you should open or maintain the account. This may include ordering a credit report or other report information from any motor vehicle department or other state agency) on me. | have received a copy of the applicable account agreement and the privacy policy (each may be amended from time to time) and agree to be bound by their terms. | also agree to the terms of the dispute resolution program described in the foregoing agreements. Under the dispute resolution program, our disputes will be decided before one or more neutral persons in an arbitration proceeding and not by a jury trial or a trial before a judge. Customer 1 Name RL¢ PEREZ Customer 1 Signature Submit manually Date Cl Signature not required 11/1 of 2 OIC ol -Use Wells Fargo Confidential 2 »-000 DSG8921 (5-16 SVP) ew EFTA00125033