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Additional Business Owner (3) <br />First Name <br />Ownership Percentage <br />Date of Birth 1 <br />J <br />Residence Address <br />Street Address 1 <br />Street Address 2 <br />City <br />ZIP <br />Additional Business Owner (4) <br />First Name <br />Ownership Percentage <br />Date of Birth <br />i <br />Residence Address <br />Street Address 1 <br />street Address .2 <br />City <br />(ZIP <br />t <br />Banking and Processing <br />Deposit and Withdrawal Bank Account <br />Bank Name <br />Last Name <br />SSN <br />Mobile Phone <br />State <br />Country <br />Last Name <br />SSN <br />Mobile Phone <br />17 -- <br />State _ <br />Cpuntry <br />Account Type <br />Business Checking O Savings <br />-- --_ �— <br />Routing Number Account Number <br />A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />J.R. SMITH, CLERK <br />Page 4 of 11 CardConnect LLC is a registered ISO of Wells Fargo Bank, N.A., Concord CA Version CardCo2305 <br />