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PATRIOT ACT INFORMATION DISCLOSURE

PATRIOT ACTINFORMATION DISCLOSUREA pplicant NameCo-Applicant NamePresent AddressMailing AddressTo help the government fight the funding of terrorism and money laundering activities, Federal law requires all financialinstitutions to obtain, verify, and record INFORMATION that identifies each person who opens an this means for you: When you open an account, we will ask for your name, address, date of birth, and otherinformation that will allow us to identify you. We may also ask to see your driver's license or other identifying acknowledge that I/we received a copy of this Form 04/04 Organization, or EntityIdentification DocumentationPatriot ActThe USA PATRIOT Act requires all financial institutions to obtain, verify and record INFORMATION that identifies every of this documentation is required in order to comply with the USA PATRIOT Act.

PATRIOT ACT INFORMATION DISCLOSURE Applicant Name Co-Applicant Name Present Address Mailing Address To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial

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