CCB-1149 DEPOSITORY INSTITUTION AUTHORIZATION FORM Instructions This form is to be completed by an authorized principal or officer of the applicant in order to authorize the addressed financial institution to provide information to this Bureau regarding the history of its account relationship s with the applicant. If the applicant is a start-up company or has accounts that have been open less than one year this form should authorize the addressed institution to provide account relationship information for the principals members partners or trustees of the applicant with one form to be completed per individual. If the applicant is a sole proprietorship this form should authorize disclosure of all account relationship information of the proprietor. TO Name of Bank Street Address City State Zip ATTN Contact Person and Title - Optional Phone Number If Applicable FROM Full Name of Company or Individual Name of Account Holder or Authorized Signer any and all information regarding all of the ....
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How to fill out the CCB-1149 online
The CCB-1149 is an essential form used to authorize financial institutions to share account information with the appropriate regulatory bodies. Completing this form accurately is crucial for ensuring that your financial history is properly communicated and documented.
Follow the steps to complete the CCB-1149 online effectively.
- Click the ‘Get Form’ button to access the CCB-1149 form and open it for editing.
- In the 'TO' section, provide the name of the bank or financial institution you are authorizing. Ensure it is spelled correctly.
- Fill in the street address, city, state, and zip code of the bank to complete the 'TO' section.
- If applicable, include the contact person’s name and title in the 'ATTN' section, along with their phone number.
- In the 'FROM' section, write the full name of your company or your individual name.
- Complete the street address, city, state, and zip code in the 'FROM' section.
- Add your phone number in the specified area of the 'FROM' section.
- In the authorization statement, enter the name of the account holder or authorized signer in the blank provided.
- Fill in the name of the bank again to confirm who is authorized to release information.
- In the final part, state the name of your company or your own name again, ensuring that it matches the previous entries.
- Write the date on the designated line where indicated.
- Sign the document in the signature line, and include your title if applicable.
- After completing the form, review the information for accuracy. You can then save changes, download, print, or share the completed form as needed.
Start filling out your CCB-1149 online today to ensure your authorization is processed promptly.
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