IRA Contributions Agreement

By completing and signing this form, you authorize The Bancorp Bank to ACH funds from your account at your financial institution to an IRA account with The Bancorp Bank.

Account information at The Bancorp Bank:

Name: ______________________________________  IRA Account Number: ______________________ 
Address: _______________________________________________________________________________ 

Payment Amount:

Recurring IRA contributions will begin for tax year ____________ 
Annual recurring contribution limit ___________ 

Please specify a dollar amount and the schedule of which you would like the automatic contributions to occur. If you do not specify an amount, or if you do not establish a regular contribution schedule, we will automatically establish a limit based on the current Federal limitations of $3,000.00 for a contribution year. For each contribution, current year transfers will stop once you've reached this dollar amount. Your transfer schedule will be reactivated in January of the next contribution year. Prior year contributions cannot be made using this program.

(Note: This contribution method does NOT apply to Certificate of Deposit accounts)

Frequency: Beginning date Transfer amount
One Time  ___________   ___________ 
Quarterly  ___________   ___________ 
Monthly  ___________   ___________ 
Bi-Weekly  ___________   ___________ 
Weekly  ___________   ___________ 

Account information for other Bank/Financial Institution:

Financial Institution Name:  _______________          Financial Institution ABA:  _______________ 
Primary Name on Account:  _______________          Account Number:  _______________ 

Witness the hand and seal of the undersigned this:

Signature: _______________________________ 
Date: _______________ 

Please submit this form to: The Bancorp Bank, Attn: IRA Services, 409 Silverside Road, Wilmington, DE 19809

Please attach a voided check. Financial Services provided by The Bancorp Bank
Member FDIC, Equal Housing Lender