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IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person 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.

Basic Information
Apply For: (Select only one)

Personal Net Certificate of Deposit (CD)

Personal Net Individual Retirement Account (IRA)*  

* Please call us so we may mail you the necessary forms.

CD Interest Payment Options: (Select only one)

Automatically Compound to CD
Direct ACH Credit to an account at another financial institution (*)

(*) Please attach a voided check for account verification.

Initial Deposit $ By:  Wire    Mail    In Person

Type of Account: (Please indicate)
 Individual    Joint    Trust  

Joint Account Options: (Please indicate)
 Tenancy in common account
 Community property account of husband and wife
 Joint account of husband and wife with right of survivorship

Trust Options: * (Please indicate)
 Formal Trust - Certification of Trust form required*
 Totten Trust **
 Pay-On-Death **

** For this type of trust account, please provide the name, social security number and address of beneficiary:

Name:
SSN:
Address:

Agreements
Customer Information Profile

For each account holder, please complete print, sign and mail the Customer Information Profile and submit with this application.


Certification of Trust For Deposit Accounts

For a Formal Trust account, please complete the Certification of Trust form.



Applicant Backup Withholding Certification

1. TAXPAYER ID NUMBER
   My correct Social Security Number is shown below.
   
2. BACKUP WITHHOLDING
   I am not subject to backup withholding because either I have not been notified of being subject to backup withholding as a result of failure to report all interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding.
   
3. EXEMPT RECIPIENTS
   I am an exempt recipient under the Internal Revenue Service (IRS) Regulations.
   
4. NONRESIDENT ALIENS
   I am not a citizen or a resident of the United States. Nonresident aliens must complete and remit IRS Form W-8BEN (click link to download this form from the IRS.)

Tax Payer ID Number / Social Security Number:

Under penalties of perjury, I certify that (1) the social security number indicated above is my number and (2) I am not subject to backup withholding as a result of failure to report all interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding, (3) I am a U.S. Citizen (includes a U.S. resident alien). You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.

Applicant Signature: _____________________________________________ Date: ___________


Information
I understand that this is an application for an account with Pacific Mercantile Bank and is subject to approval. Everything that I have stated in this account application and applicable agreements is/are correct to the best of my knowledge. You are authorized to verify credit, employment history, inquire into past banking relationships and/or order a credit report form a credit reporting agency. My original signature must be on file before the account can be opened.

All authorized account holder signatures must be present on this form:

Applicant Signature:


Printed Name: _________________________________________ Date: ___________


Co-Applicant Signature:


Printed Name: _________________________________________ Date: ___________


Instructions

In addition to the original signed application, you will need to send copies of all documents that are needed to identify you.

• Please include a legible copy of your driver’s license.
• Although we will send mail to a PO Box, we do need your physical street address on file.
• For a trust account, please provide the Certification of Trust form with this application.

Without proper documentation your account will not be opened/or will be closed and the funds returned without interest. Copies or faxes copies of the signed account application will not be accepted.

Please Mail the Completed and Signed Account Application and Applicable Agreement(s) to:

Pacific Mercantile Bank
Central Operations/CD Desk
949 South Coast Drive, 3rd Floor
Costa Mesa, CA 92626