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					Please do not write or staple above this area. This area is reserved for bar code and processing. Mail or FAX to: H&R Block Bank P.O. Box 10364 Kansas City, MO 64171-0364

Clarify case #

Business Account Application
Application to Open a Checking, Savings, Money Market or CD Account with H&R Block Bank

FAX: 816-854-8050

Business Name & Address Legal Name (Name that appears on documentation filed with the State)

Doing Business As (Trade Name)

Physical Address (No PO Boxes) ______________________________________________________________________________________________
Street Suite City State Zip

Check if business is run out of your home

Date moved to current address (mm/dd/yyyy) ________________

Mailing Address for Statements & Correspondence (if different than permanent address) ______________________________________________________________________________________________
Street Suite City State Zip

Phone:

FAX:

E-mail address:

If the address above is not the address of the principal office of your business, please indicate by state or province the location of the principal office. Within the United States? Yes No State/Province ___________________ Business Structure TIN (SSN, if no Tax ID)
Closely Held Corporation Corporation General Partnership Limited Liability Corporation

Date Established

Date Purchased (If current owner did not start business)
Limited Liability Partnership Limited Partnership Municipal Not for Profit

# of Employees

Professional Association Publicly Traded Company Sole Proprietorship

Nature of Business

Does business provide money services to its customers (e.g., check cashing, issuing money orders or travelers’ checks, exchanging currency or wiring funds) in exchange for a fee or as a courtesy? Yes No
Check if you are an existing H&R Block Bank Customer

Last Fiscal Year Gross Sales $ Owner/Officer Information Name Country of Residence Permanent Address Net Profit $

SSN/TIN Country of Citizenship

Date of Birth (mm/dd/yyyy)

______________________________________________________________________________________________
Street City

Identification (USA Patriot Act requires identity verification of anyone seeking to open an account.

State Zip Please provide Government-issued identification)

_________________________________________________________________________________________________
Type (e.g., Drivers license) Issuer (e.g., State or Agency) Number Issue Date (mm/dd/yyyy) Expiration Date (mm/dd/yyyy)

Deposits are accepted by H&R Block Bank, a Federal Savings Bank, Member FDIC.

Account Type

Select the Type of Account You Wish to Open (Minimum Deposit $25; except for CDs, which is $250) Checking Interest Checking Savings Money Market Certificate of Deposit (please circle desired term)* 30 Days 12 Months 3 Years 90 Days 8 Months 4 Years 180 Days 2 Years 5 Years *CDs are opened as Auto-Renewable unless the customer designates a preference of Single Maturity. Please circle the desired option below. If neither option is circled, the CD will be automatically renewed based on current market rates, upon maturity. Single Maturity Auto-Renew

Additional Services
ATM Card (not available on CDs). Number of cards requested _____ Online Banking Online Bill Pay (not available on Savings, Money Markets and CDs)

Initial Deposit Methods for checking or savings accounts** (Select One)
Check Enclosed Amount $____________ Include a business check, cashier’s check or money order made payable to you, endorsed with your signature and “For Deposit Only” on the back of the check. Transfer from Existing Checking* or Savings Account Amount $___________

Financial Institution ______________________ Routing Transit # (9 digits) __________________ Account # _________________ * Transfers from a checking account require a voided check. Please attach the voided check upon application submission. **Please note that Certificate of Deposit accounts may only be opened using a check and cannot be opened using an ACH deposit.

Signatures

________________________________
Applicant/Owner

___________________________
Date

_________________________________________ Applicant/Owner

__________________________________ Date

Please print the name and title of any authorized signers for this account other than the applicant/owner above. 1.) __________________________________ 3.) __________________________________ 2.) ______________________________________ 4.) ______________________________________

Deposits are accepted by H&R Block Bank, a Federal Savings Bank, Member FDIC.

Business Application - Instructions
Application Process • Please complete the application, providing the information requested so that we may verify your identity and properly setup your account if approved. o o Be sure to indicate how you want to make your initial deposit (transfer from an existing account or by business check, cashier’s check or money order) Please note that Certificates of Deposit may only be opened via check. We are unable to process the establishment of a Certificate of Deposit using the transfer method from another account. Be sure the owner or authorized officer of the Company signs the application

o •

Mail or FAX your application to the following: o o FAX to 816-854-8050 (only if initial deposit is via transfer from an existing account) Or mail your application to: H&R Block Bank P.O. Box 10364 Kansas City, MO 64171-0364

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Once we receive the signed application and opening deposit, we will process your application. Upon approval, we will mail an H&R Block Bank Welcome Kit to you. It will contain your new account number and information, product disclosures, interest rates if applicable and further instructions for accessing your account. Debit cards, ATM cards and online account access information will be sent separately. Section 326 of the Federal USA Patriot Act requires all financial institutions to verify the identity of any person seeking to open an account. This law mandates that we verify certain information about you while processing your account application. We may communicate with you via the phone number or e-mail address supplied in your application.

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Deposits are accepted by H&R Block Bank, a Federal Savings Bank, Member FDIC.


				
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posted:3/26/2009
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