EFTA00283612.pdf

Aug 11 2014 11AOAM HP Fax Page 1 relt Bankwell Fax To: off From: ( AMALI-OrCits/0 Fax: Pages: (INCLUDING COVER) Phone: Date: O H M / Re: kas2“Al l CC: R'S Urgent G For Review O Please Comment O Please Reply O Please Recycle • Comments: The infomution contained in this facsimile message is intended only for the personal and confidential use of the designated recipient rained above. This message is privileged and confidential.If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error and any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify me immediately by telephone at (203)6524322 and retain the original message to ire by mail Thank yo 208 Elm Street, New Canaan, Cr 06940 Phone (203) 972-3830 Fax (203)968.7473 EFTA00283612 Aug 11 2014 11:00AM HP Fax NEW ACCOUNT INFORMATION Financial Institution Name And Address * Banicvveit . BanKve it DATE 08/07/2014 Check If applicable: n Temporary 0 Replacement ACCOUNT INFORMATION AMOUNT OF DiPCSIT 1 25,000.00 PLAN if ACCOUPC fort16'.,* Tint OF ACCOUNT ACCOUtr REOHAWK PARTNERS LLC DANIEL M GROFF LESLEY K GROFF OWNERSEIP TYPE ac - T PRODUCT NAME Bankwell Business Checking won* runton a tam= InolFINI TY •c.. amid* enly when nrket 14.Z. Cprad IIII Lan Torcasio BUSINESS ENTITY INFORMATION trallOSS FLSIO STATE BUS NESS NAME AND ADDRESS ENTITY COCLWENI REOHAWK PARTNERS LLC LAST FUND DATE RUNG EXPIRATION DATE ESTABLISHED NATURE OF ()AIWA PR MARY LOCATION ASSUMED NAME 1F DMA RESOLUTION DATE E-MAL ADORE% CONTACT NAME FACSIMILE AUTHORIZATION ON Fitt 0 YES IA CONTACT TITRE • LIMITED L MILEY COMPANY TAX CIASSIRCATION: CONTACT PHONE BUSINESS ENGAGES IN IN-ERFET GAMBLE/3 • 0 OTNER •ll Pm 4 44cIal YOU mull 4414•44IIAM o4 **140414Y M **Ele In Mehl Gernetne. TAXPAYER IDENTIFICATION NUMBER CERTIFICATION Exempt payee code, if any: Under penalties of perjury, I certify that: Exemption from FATCA reporting code, if any: 1. The number shown on this form Is my correct taxpayer Identification number (or I am waning for a number to be Issued to me), and 2.1 am not subject to backup withholding because: its) I am exempt from backup withholding, or ID) I have not Revenue Service (IRS) that I am subject to backup withholding as a result of a faille to report all interest or been notified by the Internal notified me that I em no longer subject to backup withholding (Notice: If you are subject dividends. or (c) the IRS has to backup withholding, cross out this tine), and 3. 1 an a U.S. citizen or other U.S. person Iderined In the Wil Instructions), and 4. The FATCA codels) entered on this form (if any) Indicating that I am exempt from FATCA reporting is correct. Taxpayer Idantificartion Number: 47-1607018 08/072014 SIGNATURE DANIEL M GROFF DATE ADDITIONAL TERMS Account Alternate Address: IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT. To help money laundering activities, Federal law requires all linencial Institutions to obtain, verify, and the government fight the funding of terrorism and opens an account. record information that Identifies each person who What this means for you: When you open en account, we will ask for your name, address, to Identify you. We may also ask to see your driver's license tr. other Identifying documents. date of birth, and other information that will allow us ACKNOWLEDGMENT. By spning this document, the undersigned acknowledge that they have received, understand and agree to be bound by the terms of the Account have opened the type of account designated above, and information provided to the institution is true and accurate. If this is a consumer Agreement for that account type. The undersigned certify that all account, the undersigned acknowledge receipt of an Account Disclosure, end a copy of this institution's Privacy Policy. The undersigned also acknowledge Availablity Policy and/or Electronic Fund Transfer Agreement. If this account is opened receipt whore applicable, of this Institution's Funds in the name of the bareness entity, all signers are acting on behalf of the business entity. All signers authorize this institution to make inquiries protection service, in correction with this account from any consumer reporting agency, including a chock NUMBER OF =NATURES Riaumm: El Authorized SON 3 FACSIMILE ALLOWED One litITE Auth Signer rated Spier Oely Tale: Auth Signer I ' DANIEL M GROFF 08/07/2014 Cror LESLEY K GROFF 08107/2014 one • AuStrbelEknitOlk TAW 0 Aviteleed Sire ONE The: X X Dete Come =seamen hilt MO ITCIIMiSAII•I NMI% Pie I N 2 ••••••••-•.L.----.—..— EFTA00283613