AUTHORIZED SIGNERS
FRM 500 02.10.2023
Form - Authorized Signers
U.S. Bank
Employer:
Plan/Trust Name:
Authorized Signers
In accordance with the provisions of the above referenced account, the following people are authorized on behalf of the Employer to direct U.S. Bank, N.A. to take action with regard to this account and hereby authorize and direct U.S. Bank, N.A. to act on directives signed by:
1. Print Full
Legal Name:
First Name Middle Name Last Name
Print Title: Email:
Signature: Direct Phone Number:
2. Print Full
Legal Name:
First Name Middle Name Last Name
Print Title: Email:
Signature: Direct Phone Number:
3. Print Full
Legal Name:
First Name Middle Name Last Name
Print Title: Email:
Signature: Direct Phone Number:
4. Print Full
Legal Name:
First Name Middle Name Last Name
Print Title: Email:
Signature: Direct Phone Number:
Authorized by:
I hereby acknowledge and represent that I am authorized on behalf of the Employer to provide this authorized signature form to U.S. Bank, N.A. This form shall remain in effect until it is changed or revoked in writing by the Employer. Any change or revocation of this form shall be effective upon U.S. Bank’s receipt of such written notice.
Print Name of Authorized Signer for Employer Title of Authorized Signer for Employer Signature of Authorized Signer for Employer Date Signed SAMPLE
Attachment 8