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Rev 2/2019
For Bank Use Only
Business Name Account Number Account Officer
Instructions
1. Assist customer in completing the account application, principally in the following 3 areas:
Explain products and services. It is important to align the customer’s needs and
expectations with our products and services. Not all customers will qualify, based on their
business activity or industry, for all of the services we offer. This is also an opportunity to
cross sell customer for services they may need and did not know we offer.
Define expected account activity. Ask questions about the business to determine the
account activity level that will be expected from the business. ( Transactions for an
operating account will be different than ones in a payroll account) Remember, it is all in
the delivery. We can use this opportunity to learn about their business in a friendly and
respectful manner. This can be tricky as the customer may feel the questions are over-
reaching or intrusive, however, we have to comply with BSA/AML requirements.
Define entity structure. Ask questions about the ownership structure so the beneficial
ownership is addressed up front and the forms are completely correctly. If the business
entity is owned by another entity then we have to obtain additional information to
appropriately document the file. This applies to both loans and deposits. By using this
opportunity to discuss the business in a friendly manner, we can mitigate t
he risk
by knowing
our customer while establishing a rapport with our customer.
2. Obtain any additional application forms required based on the products and services
requested. For example, if the customer is requesting remote deposit capture then an
additional agreement is required.
3. Complete the BSA/AML form (Expected Transaction Activity & Beneficial Owner/Control)
4. Complete the BSA Risk Assessment.
5. Complete the ATM Information Form, if applicable. (Obtain copies of ATM contract and photos)
6. Obtain the entity documentation.
7. Verify CIP for each individual and entity involved and sign off when completed.
8. Review the BDO section of the checklist to ensure application is complete.
9. Scan package and submit to Operations electronically.
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Business Name
DBA (if applicable)
Date Established
Address
City
State
Zip
Mailing Address (if different)
City
State
Zip
Business Phone
Business Website
Tax ID #
Contact Name
Contact Email
Contact Phone
Business Deposit Account Application
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 on personal accounts identifies each person who opens an
account. In addition, on legal entity accounts, we will require identification on beneficial owners and controlling
person.
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.
Account Information
Services Requested
PRODUCTS
OTHER SERVICES
Checking – Free 50
On-line Banking
Checking – Interest First
Cash Management*
Checking – Optimized (Analysis)
Mobile Banking
IOLTA Account
Debit Card*
Virtual Vault Checking**
Checks
Business MMA
ACH Origination**
Certificate of Deposit Term ______ Month(s)
CD Interest Credit to:
☐ Compound (Add back to CD)
☐ Credit to ☐Internal ☐External Account (Enter RTN below)
☐DDA ☐SAV Acct# ___________ Bank RTN____________
Acct#____________
Remote Deposit Capture (RDC)*
Wire Transfers*
*CBB Agreement Required
**Additional Approval Required
Business Type Information
Type of Business: (i.e. Retail, Wholesale,
Manufacturing, Service Provider)
Number of locations: Attach a list
of location addresses.
Nature of the Business:
(Please briefly describe
what you do, your product or services)
What is the NAICS
code?
Number of Employees:
#
Annual Revenues (Sales)
$
Any likely seasonal factors?
(tourists, summer or winter related
business?)
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How were you introduced to California Business Bank?
Does the business, principals or affiliates currently have accounts with CBB?
If yes, list accounts below.
If no, please provide the last 3 months of bank statements from your current banking
institution.
Yes
No
Account Name(s)
Account Number(s)
List the Markets or Areas serviced:
Does the Business/Entity serve International Markets?
Yes
No
Is the Business/Entity based out of a residence?
Yes
No
Does your business engage in Internet gambling?
Yes
No
Does your business provide remittance services? Circle below if applicable.
Yes
No
(Check Cashing, Western Union, Money Orders, Prepaid/Payroll cards or similar services)
Is your business/profession in any of the following industries? Circle below if applicable. Yes No
(Casino/Card Club, Jewelry/Precious Metals, Travel Agency, Vehicle Seller, Pawn Broker, Loan/Finance Company)
Is the business engaged in or associated with the marijuana industry?
Yes
No
Does your business have an on-site ATM? If yes, complete the Privately Owned ATM Info Form, provide copy
of your ATM contract and photos.
Yes
No
Is your business incorporated in another state? If yes, please provide filed authorization to conduct business in this
state.
Yes
No
Do any of the signers on the account hold or have they ever held political office in a foreign country? If yes, please
include the name(s) of signer(s) and name of country:
Yes
No
Business Entity
☐ Sole Proprietor
☐ Limited Liability Company (LLC)
☐ Limited Liability Partnership (LLP)
☐ Non-Profit Corporation
☐ Trust
☐ Corporation
☐ Limited Partnership (LP)
☐ General Partnership (GP)
☐ Non-Profit Organization
☐ IOLTA
Account Expected Transaction Activity
Purpose of Account: ☐ General/Operating ☐Payroll ☐Other (Specify Wires, Escrow, etc.)______________________
Transaction Types
# per month
Total Monthly Amount
Total Debits
Sources
Check Deposits (RDC/Mobile)
$
Cash Deposits
$
Cash Withdrawals
$
Automatic Credits (ACH)
$
Automatic Debits (ACH)
$
Incoming Wires
$
Outgoing Wires
$
International (list Countries)
$
Please provide names of primary trade partners if applicable (i.e. Buyers, Suppliers, Distributors, Creditors…etc.)
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Business Structure and Ownership Information
This section must be completed by the person opening the account on behalf of the account holder.
Name of person opening the account: _____________________________________________________
Name of Legal Entity for which the account is being opened: __________________________________________
Step 1: Significant Responsibility
Please provide the following information for one individual with significant responsibility for managing the legal entity named
above such as an executive officer or senior manager (e.g. Chief Executive Officer, President, Executive Vice president, Vice
President, Chief Financial Officer, Chief Operations Officer, Managing Member, or General Partner) or any other individual
who performs similar functions.
Note: If applicable, this person may be one of the owners listed on page 3.
Name
Title
Home Street Address (Not a P.O. Box)
Home City, State, Zip
Home Phone Number
Work Phone Number
Cellular Phone Number
Social Security Number (for U.S.
persons)
Date of Birth
Passport number and country of
issuance (for foreign person)
Government Issued Identification #
Issue Date
Expiration
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Step 2: Ownership
Please list each individual owner (if any) who, directly or indirectly, through any contract, arrangement, understanding,
relationship or otherwise, owns 25% of the equity interests of the legal entity listed above.
Note: If any percentage of ownership is owned by any entity other than an individual (natural person), please complete an
additional ownership worksheet for every non-natural person owning 25% or more.
Business Name
Owner #1
Owner #2
Owner #3
Owner #4
Name
Title
% of Ownership
Home Street Address
(Not a P.O. Box)
Home City, State, Zip
Mailing Street Address
(If different)
Mailing City, State, Zip
Home Phone Number
Work Phone Number
Cellular Phone Number
Social Security Number
(for U.S. persons)
Date of Birth
Passport No &
Country issued (for
foreign persons)
Identification Issuing
Agency
Government Issued
Identification #
Issue Date
Expiration date
City & State of Birth
Mother’s Maiden Name
Will you be an authorized
signer on the account?
Yes☐ No☐
Yes☐ No☐
Yes☐ No☐
Yes☐ No☐
I, (insert name of person and title authorized by business
entity) hereby certify, to the best of my knowledge, that the information provided above is
complete and correct.
x Date: _____________
Please print name:
Please print title:
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Step 3: Authorized Signers: Please complete the worksheet below for all authorized signers that are NOT
listed as owners on page 6.
Authorized Signers
(All authorized signers that are NOT owners listed above)
Authorized Signer
#1
Authorized Signer
#2
Authorized Signer
#3
Authorized Signer
#4
Name
Title
Role in Business
Home Street Address
Home City, State, Zip
Mailing Street Address
(If different)
Mailing City, State, Zip
Home Phone Number
Work Phone Number
Cellular Phone Number
Social Security Number
Date of Birth
Identification Issuing
Agency
Government Issued
Identification #
Issue Date
Expiration date
City & State of
Birth
Mother’s Maiden Name
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BSA/AML DEPOSIT Risk Rating Analysis
NAICS Code (2007) website: http://www.census.gov/eos/www/naics/
1. Is customer a prohibited High Risk Industry business - Check Cashing; Currency Exchanger; Money Service
Business (MSB)? _____If yes, then do not open the account as it is prohibited by bank policy.
2. If you answered “No” to question #1 above, then proceed with assessing a BSA Risk Rating of the business account below.
Industry Risk Score
Chart
Automatic High Risk Industry =
9
Do not open the account without prior approval of President, BSA Officer, or Chief Compliance Officer per bank
po
li
cy
.
Off Shore Corporation
Non-Governmental
Organization / Chari
t
y /
Non-Profit
(Foreign)
Wire (money) Transmitter
High Risk Industry Score =
7
Accountants and Bookkeepers
Gas
Stations
Parking Garages
Airplane Dealers (New and Used)
Fire arms and Ammo
Other Non-Bank Financial Institutions
Attorneys and Paralegals
Heavy Equipment Sales (New and Used)
Pawn
Brokers
Automobile Sales (New and Used)
Import/Export Companies
Restaurants
Casinos and Card Clubs
Investment Brokers and Advisors
Ship, Bus, and Plane Operators
Convenience/Liquor Store
Jewel, Gem, or Precious Metal Dealers
Travel Agencies
Doctors, Physicians, and Nurse Practitioners
Machine Parts Manufacturers
Trucking Companies
Farm Equipment Sales (New and Used)
Motorcycle Dealers (New and Used)
Medium Risk Industry Score = 6
1031 Exchange Accommodators
Hotels/Motels
Retail
S
t
ores
Auctioneers
Large Vehicle Dealers (RV, Trailers, ATVs,
MC)
Salvage/Recycling
Boat Dealers (New and Used)
Leather Goods Store
Telemarketers
Brokers/Dealers (including Insurance)
Non-Gov.
Org / Charities
/
Non-Profits
(Domestic)
Wholesale Distributors
Deposit Brokers
Property Management
Low Risk Industry =
0
All other
industries
Industry Score from Chart above:
Industry Score:
Circle Y/N – Enter Pts
*
The term “local” refers to CBB’s Core or Expanded Service Area,
1.
Are business locations local?
Y = 0
N = 1
2.
Are major customers local?
Y = 0
N = 1
3
Do owners reside locally?
Y = 0
N = 1
4.
Is business older than 2 years? (If not original owner, date of purchase. ____/____/____)
Y = 0
N = 1
5.
Does business operate in local trade area?
Y = 0
N = 1
6.
Is Business an International Entity?
Y = 6
N = 0
7.
Will Business send/receive International Wire Transfers?
Y = 6
N = 0
8.
Is stated cash volume inappropriate for business?
Y = 6
N = 0
9.
Is stated wire activity volume inappropriate for business?
Y = 6
N = 0
10.
Are monthly cash transactions > $15,0000?
Y = 6
N = 0
11.
Are ACH transactions (incoming/outgoing) inappropriate for business?
Y = 6
N = 0
BSA RISK RATING
Total points (including the industry score) and enter here →
SCORE
RATING
0 – 3
Low
4 – 8
Medium
9 and above
High
Note: You must copy the BSA Officer with the electronic submission of any Medium or High Risk Account
Risk Rating Performed By:
Employee Name
Signature
Date
NAICS CODE: ___ ___ ___ ___ ___ ___
For Bank Use Only
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Rev 2/2019
Business Name Account Number Account Officer
Application Checklist
BDO
OPS
1.
Application completed, reviewed for accuracy, completion and signed by
customer?
Yes
No
2.
Ownership identified correctly?
Yes
No
3.
Complete entity documentation obtained and reviewed?
Yes
No
4.
CIP completed, reviewed, verified and signed by bank employee?
Yes
No
5.
BSA/AML Risk Analysis completely correctly?
Yes
No
6.
Review questionnaire (Internet gambling, Marijuana, Remittance industries)
Yes
No
7.
Conduct site visit for all cash intensive businesses (ideally with photos of store
front and Private ATM).
Yes
No
8.
On-site ATM on premises?
If YES, are required forms received?
PATM Form, Copy of ATM Contract and Site visit with photos.
If NO, (No ATM is on site and is confirmed via site visit photos) check N/A
Yes
N/A
9.
Have 3 months of bank statements been collected?
Yes
No
If any question is answered “No”, please provided explanation below:
No.
No.
If BSA Risk Rating is “Medium” or “High”, BSA Officer MUST be notified PRIOR to opening the account
Name of BDO
Signature
Date
Name of Ops
Signature
Date
BSA Review (when applicable)
Signature
Date
Note: Package must be scanned and submitted electronically to operations. If medium or high risk
please copy BSA officer on application submission. If package is incomplete, the application will not
be accepted and returned the submitting officer.
