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Close up of a woman sitting at a desk with an open notebook while she writes on a paper with a blue pen.
Customer Due Diligence
Required Business Information
"
*
" indicates required fields
Business/Entity Name:
*
Date Business Started
*
Month
Day
Year
Name of Person Providing Information:
*
First
Last
Please provide an answer to each question below, even if unknown or not applicable.
1. Is your business licensed and/or registered in the State of Mississippi?
*
Yes
No
2. How long have you been in business?
*
3. Describe the specific service or product you provide.
*
4. Are you a Money Services Business (MSB) or provide MSB-type services such as check cashing, money transmission, money order/travelers cheques/stored value card sales?
*
Yes
No
5. Will the business be conducting, processing or otherwise involved in betting, gaming, or gambling activity, in whole or in part, over the Internet?
*
Yes
No
6. Do you own, operate or replenish an ATM?
*
Yes
No
7. Is your business a marijuana-related business or connected to one?
*
Yes
No
6. Amount of opening deposit:
*
7. Average balance that will be maintained in the account:
*
8. What types of deposits will typically be made into this account?
*
Mark all that apply.
Checks
Money Orders
Wire Transfers
Cashiers Checks
Cash
ACH - Electronic Deposit
9. What is the estimated dollar amount of your monthly deposits by check?
*
10. What is the estimated dollar amount of your monthly deposits by cash?
*
11. What is the estimated dollar amount of your monthly cash withdrawals?
*
12. How many incoming/outgoing wire transfers will you have each month?
*
13. Will you cash checks for third parties?
*
Yes
No
14. Are there any other transactions that you will be performing that we need to know about?
*