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NFG #2 Checking/Savings Application

Transfer from current account
Transfer from another institution
Check/Money order
ATM card
ATM check/debit card
Credit card
Direct deposit

Individual    Joint   

Primary Account Holder


TIN Certification and backup withholding information

By completing and submitting this document, I certify, under penalties of perjury

  1. that the Social Security Number (SSN)/Taxpayer Identification Number (TIN) shown is my/the correct number

  2. that I am NOT, unless designated below, 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 dividends or interest, or because the IRS has notified me that I am no longer subject to backup withholding

  3. that I am a U.S. person (including a U.S. resident alien)