ACCOUNT AGREEMENT

Alpine Bank Account 8911609785

Edwards Number:
0069 Edwards Access Rd, Suite #4 Account Owner(s) Name & Address
PO Box 2205
ELVIS JAIR JIMENEZ TINOCO
Edwards, CO 81632-0000
2425 KINNIKINNICK ROAD 62
Agreement Date: 03/17/2022 By: D Aguirre
VAIL,CO 81657
l EXISTING Account - This agreement replaces previous agreement(s).
Account Description: Liberty

X Checking l Savings l NOW l

l
Initial Deposit $ Source: Check

Ownership of Account - CONSUMER (Select One and Initial) Additional Information: N/A
X
l Single-Party Account l Trust-Separate Agreement
l Multiple-Party Account
l Other

Rights at Death (Select One and Initial)

X
l Single-Party Account
l Multiple-Party Account With Right of Survivorship
l Multiple-Party Account Without Right of Survivorship Signature(s). The undersigned certifies the accuracy of the information he/she has
l Single-Party Account With Pay On Death provided and acknowledges receipt of a completed copy of this form. The undersigned
authorizes the financial institution to verify credit and employment history and/or have
l Multiple-Party Account With Right of Survivorship a credit reporting agency prepare a credit report on the undersigned, as individuals.
and Pay On Death The undersigned also acknowledge the receipt of a copy and agree to the terms of the
Pay-On-Death Beneficiaries. To Add Pay-On-Death Beneficiaries Name One or More: following agreement(s) and/or disclosure(s):
lX Terms & Conditions l X Truth in Savings l X Funds Availability
X
l Electronic Fund Transfers X
l Privacy l Substitute Checks
l Common Features l
The Internal Revenue Service does not require your consent to any
provision of this document other than the certifications required to
avoid backup withholding.

(1): [ X
ELVIS JAIR JIMENEZ TINOCO
]
Ownership of Account - BUSINESS Purpose
I.D. # JAA6409 D.O.B.

l
l
l
Sole Proprietorship l
LLC (LLC tax classification: l C Corp
C Corporation l S Corporation
Single-Member LLC l Partnership
l S Corp l Partnership)
l Non-Profit
(2): [ X ]
l I.D. # D.O.B.
Business:

Backup Withholding Certifications (Non-"U.S. Persons" - Use separate Form W-8)

X
l By signing at right, I, ELVIS JAIR JIMENEZ TINOCO
certify under penalties of perjury that the statements made in this section are true.
,
(3): [ X ]
I.D. # D.O.B.
X TIN: XXX-XX-3793
l The Taxpayer Identification
Number (TIN) shown is my correct taxpayer identification number.
X
l Not Subject to Backup Withholding. I am NOT subject to backup
withholding either because I have not been notified that I am subject to backup
withholding as a result of a failure to report all interest or dividends, or the Internal
(4): [ X ]
Revenue Service has notified me that I am no longer subject to backup withholding.
I.D. # D.O.B.
l Exempt Recipient. I am an exempt recipient under the Internal Revenue Agency (Power of Attorney) Designation (Optional). To Add Agency
Service Regulations. Exempt payee code (if any) Designation To Account, Name One or More Agents:
FATCA Code. The FATCA code entered on this form (if any) indicating that I am N/A
(Select One and Initial):
exempt from FATCA reporting is correct.
l Agency Designation Survives Disability or Incapacity of Parties N/A
U.S. Person. I am a U.S. citizen or other U.S. person (as defined
in the instructions). l Agency Designation Terminates on Disability or Incapacity of Parties N/A

Signature Card-CO
Bankers Systems * VMP , MPSC-LAZ-CO 1/15/2016
Wolters Kluwer Financial Services - 2016 Page 1 of 1