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Client Profile Form - RPS - PREPAID

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					                                            Elan Financial Services
                                              Client Profile Form
                      All fields are required. If a field does not apply, enter N/A.
                                   Incomplete forms will be returned.
Client Profile

Full legal name of client business:
This name must appear on the client Agreement


Full legal address of entity:
This address must appear on the client Agreement


Primary client contact name / title / phone number


Legal entity name(s) currently doing business with
other U.S. Bank business lines:


Alternate company name(s):
(Also Doing Business As)


Taxpayer ID number (TIN):
Additionally an IRS verification Letter is required:
To receive a letter from the IRS verifying your Tax
Identification Number, please contact the Business &
Specialty Tax Line at 800-829-4933. An operator will ask
you for identifying information. You will then need to ask
for a confirmation letter to be mailed to you at their
address of record.


Principal place of business address and phone
number:


Mailing address (if different):


Domestic locations where business is conducted:


Years in business:


List business license(s) & license authority (state,
municipal, other) – License code # will suffice



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Company website address


Form of Ownership (select one)
       Partnership/LLP                            LTD Liability Company                Non-profit
       Corporation                                Domestic financial                   Unit of government
          Publicly Traded Yes No                  institution
          If Yes, List Market & Symbol:

          Other – Owner name
          Description:
          Sole Proprietorship – Owner name

If privately held, provide a listing the owners and principals.
Principal / Owner                  Title / Position                              Percentage of Ownership




Do you maintain operations, distribution sites or offices overseas?
  Yes                       No
     Afghanistan                          Cuba                        Liberia                     Philippines
     Antigua and Barbuda                  Dominica                    Libya                       Russia
     Bahamas                              Grenada                     Mexico                      Syria
     Balkans                              Guatemala                   Nauru                       Ukraine
     Bolivia                              Haiti                       Nigeria                     United Arab Emirates
     Burma/Myanmar                        Indonesia                   Niue                        Vietnam
     China                                Iran                        North Korea                 Yemen
     Columbia                             Iraq                        Pakistan                    Zimbabwe
     Cook Islands
Describe the nature/purpose of cross-border
transactions:

Program Overview

Projected Volume:
Proposed Start Date:
Current Number of Employees:
Approximate Number of Employees Receiving Paper Checks:
Employee Information(check all that apply):            Permanent       Temporary       Seasonal           Other

Payroll Funding Schedule:             Weekly           Bi-weekly             Monthly        Other
Anticipated Card Loads: Maximum:                            Minimum:



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posted:12/13/2010
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