CARD TENT

Name

Title

Email Address

Phone

You will be using our services for: You will be using our services for: Payroll Compensation Non-Payroll Compensation (ie: Rewards & Benefits) Both

Is this a one-time event? Is this a one-time event? Yes No Not Sure

How many individual beneficiaries will you be paying? How many individual beneficiaries will you be paying? 10 - 50 51 - 100 101 - 500 501 - 1000 1001 - 2500 2501 - 5000 5001 - 10000 More than 10000

If greater than 10000 Please specify

What will be the total annual payments specified in US dollars? What will be the total annual payments specified in US dollars? $10,001 - $100,000 $100,001 - $500,000 $500,001 - $1,000,000 $1,000,001 – $5,000,000 $5,000,001 - $10,000,000 $10,000,001 - $25,000,000 More than $25,000,000

If greater than $25,000,000 Please specify

What will be the frequency of your payments? What will be the frequency of your payments? Weekly Bi-Weekly Monthly Quarterly Semi-Annually Annually Periodically

Where are your beneficiaries located (Check all that apply)? Where are your beneficiaries located (Check all that apply)? USA-Only Asia Middle East, North Africa, Greater Arabia Europe North America Central America & The Caribbean South America Sub-Saharan Africa Australia & Oceana

How are your beneficiaries best described (Check all that apply)? How are your beneficiaries best described (Check all that apply)? Employees Contractors Vendors Agents Customers Other

If other Please specify

Describe the nature of your payments.

Who are you establishing an account for? Who are you establishing an account for? My Company On behalf of a Client

Legal Company Name

Website

Company Address

Tax Identification Number (Leave blank if not known at this time)

Is your Company Is your Company US Foreign

Company Type Company Type Sole Proprietorship LLC S-Corp C-Corp Non-Profit GOV

State of Organization/Incorporation

Country of Domicile

Legal Company Name

Website

Company Address

Tax Identification Number (Leave blank if not known at this time)

Is Client's Company Is Client's Company US Foreign

Is the Company Is the Company Public Private

If Public, ticker symbol

Company Type Company Type LLC S-Corp C-Corp Non-Profit

State of Organization/Incorporation

Country of Domicile