MASSB Foundation

Sample Bank Account Authorization Form

MASSB Foundation
103 Market Street
Annapolis, MD 21401  /  (443) 756-1116


[Bank Name]

[Bank Address]

[Bank's City, State, and Zip]

       Subject : Request to Open a Checking Account


Being duly authorized to act on behalf of the trustees of the MASSB Foundation, the undersigned trustee of the Foundation hereby requests  that a checking account be opened as a component fund within the MASSB Foundation:

Local Account Name: _____________________

Contact Person for Correspondence: __________________________________

Mailing Address: _______________________________________________________

Telephone: (____) ____-_______.   Email: ____________________@___________________.____

Please ensure that all associated account documentation is imprinted with the Local Account indicated above. Further, the account should reference MASSB’s Federal Employer Identification Number (EIN): 26-1192752.

Each check must be signed by one [OR: a combination of any two] of the following three people whose signatures appear below:

  • Printed Name:  _________________________________ . Signature: _________________________

  • Printed Name:  _________________________________ . Signature: _________________________

  • Printed Name:  _________________________________ . Signature: _________________________

Signed on behalf of the MASSB Foundation by --

Trustee's Signature: _______________________________________________

Trustee's Printed Name: ____________________________________________