FORM DEPOSIT

07/04/2024

Name E-mail No.

Mike Cox mdcox54@gmail.com DS-005

Bank Account Name Account Number Account Holder Name

Mike Cox 121108441 Mike Cox

Destination Bank Deposit Amount in USD Sending Bank

F&M $20,000 M&F

Terms & Conditions

Every deposit slip must be limited to one for each currency, one for type of check, or one for type of deposit. Only accepted
checks for collection shall be credited to the depositor's account and only upon receipt of proceeds.

The depositor must ensure that the correct amount shall be credited. The bank shall not be responsible for any incorrect
amount entered and validated by the teller to the deposited account.

All information that appears in the the deposit slip shall be deemed as true and correct and shall be processed by the teller
accordingly. The bank shall not be responsible for processing of any incorrect information provided and the responsible for any
information that appears and furnished shall redound to the depositor.

By signing this, I hereby acknowledge that I agree to terms & conditions.

Type a Signature
question
Accepted

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