MINOR’S TRUST ACCOUNT INFORMATION

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Minor’s Full Legal Name:  _______________________________________________________________

Minor’s Name on Trust Account:  _________________________________________________________

Social Security Number:  ________________________________________________________________

Date of Birth:  ________________________________________________________________________

                                                Month                           Day                              Year

Full Legal Name of Trustee:  _____________________________________________________________

Trustee’s Name(s) on Account:  __________________________________________________________

FINANCIAL INSTITUTION INFORMATION:

Name of Bank:  _______________________________________________________________________

Branch Address:  ______________________________________________________________________

                        ________________________________________________________________________

                                    City                              State                             Zip

Account #:  __________________________________________________________________________

Routing #:  __________________________________________________________________________

PERSON COMPLETING THIS FORM:

I declare under penalty of perjury under the laws of the state of California that the information given above is true and correct.

Name:  ___________________________________________  Relationship:  _______________________

Contact #:  ________________________________________    Date:  ____________________________

Signature:  ___________________________________________________________________________

NOTE:  A true and accurate photocopy of any information received from the financial institution confirming the creation of the trust account must be attached.