Form Mcb-O-138 Business Check Card Application
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1BUSINESS CHECK CARD APPLICATION
TELL US ABOUT YOUR COMPANY (PLEASE PRINT)
Business Name ________________________________________________________________________________________________________________________
Primary Business or Commercial Checking Account Number
TAX ID Number
National ID Number (RIF, NIT, RUT, etc.)
IMPORTANT: The Commercebank Business Check Card is a debit card for the commercial checking account identified above. It is not a credit card, and it is not
covered by consumer protection regulations governing unauthorized transactions. By signing below, you request one or more Cards for your company and certify that
the information you have given on this Application is true and complete. If your request is approved, your company and all authorized users will be bound by the terms
of the Business Check Card Agreement that you will receive with the Card(s). The Business Check Card Agreement provides, among other things, that your company
will be responsible for controlling access to and use of all Cards and associated PINs and for all transactions made and charges incurred with the Card(s).
NOTE: This Application must be signed by your company’s authorized representative(s), which means the individual(s) authorized by your company to sign a contract
relating to the checking account identified above.
Executed as an agreement this________day of _________________________ 20______.
Name ________________________________________________________________
Name ________________________________________________________________
Title ____________________________________________________________________________________
Title ____________________________________________________________________________________
Home Telephone ______________________________________________________
Home Telephone ______________________________________________________
Social Security Number ________________________________________________
Social Security Number ________________________________________________
ID Number (if applicable) ______________________________________________
ID Number (if applicable) ______________________________________________
X
X
SIGN HERE
SIGN HERE
__________________________________________________________________
__________________________________________________________________
Signature of Owner / President / Authorized Signer
Signature of Owner / President / Authorized Signer
TELL US ABOUT THE INDIVIDUALS AUTHORIZED TO USE THE BUSINESS CHECK CARD (PLEASE PRINT)
Name of Card User #1
Social Security Number
____________________________________________ ID Number (if applicable) ____________________________________________
Daily Limits*
Option 1
Option 2
Option 3
(Refer to table below)
X
X
SIGN HERE
SIGN HERE
__________________________________________________________________
__________________________________________________________________
Signature of Owner / President / Authorized Signer
Signature of Owner / President / Authorized Signer
Name of Card User #2
Social Security Number
____________________________________________ ID Number (if applicable) ____________________________________________
Daily Limits*
Option 1
Option 2
Option 3
(Refer to table below)
X
X
SIGN HERE
SIGN HERE
__________________________________________________________________
__________________________________________________________________
Signature of Owner / President / Authorized Signer
Signature of Owner / President / Authorized Signer
Name of Card User #3
Social Security Number
____________________________________________ ID Number (if applicable) ____________________________________________
Daily Limits*
Option 1
Option 2
Option 3
(Refer to table below)
X
X
SIGN HERE
SIGN HERE
__________________________________________________________________
__________________________________________________________________
Signature of Owner / President / Authorized Signer
Signature of Owner / President / Authorized Signer
*
Daily Limits
Purchases
Cash Disbursements
Option 1 (Default)
$5,000
$600
Option 2
$2,500
$600
Option 3
$200
$200
BANK USE ONLY
Bank Officer Name (print) ______________________________________________ Bank Officer Signature __________________________________________
Branch/Cost Center ____________________________________________________ Phone Number __________________________ Date____/____/________
MCB-O-138 (8/10)
Form VBCC091505
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Parent category: Business