Date: _____________________
To: The Bancorp Bank, N.A.
I hereby certify that the name ____________________ is registered under the ______________ Fictitious Name Act in the office of the Secretary of the Commonwealth on _________________________________.
Verified by: ______________________________________________
Checks, notes, drafts, acceptances, and orders for the payment of money when signed by an authorized signer, may be charged against this account until further notice.
Witness: _________________________________________________
Witness: _________________________________________________
For fast service you may fax this form to us at 302.791.5788. This form can also be mailed to:
The Bancorp Bank, N.A.
409 Silverside Road, Suite 105
Wilmington, DE 19809
Banking Services provided by The Bancorp Bank. Member FDIC. Equal Housing Lender