Checkbook - Onboarding Form
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Company Name
*
Contact Person
*
First
Last
Company Structure
*
--- Select Choice ---
Corporation
LLC (Limited Liability Company)
Partnership
Sole Proprietorship
Joint Venture
Traditional Partnership
Limited Partnership
Limited Liability Partnership
State of Incorporation/Organization
*
--- Select Choice ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Company Website
Federal of Contact
Contact Email
*
Contact Phone
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Federal Employer Identification Number (XX-XXXXXXX)
*
Licensing and Compliance Policies (e.g., customer data protection policies)
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Compliance Policies and Regulatory Matters Please provide copies of your current, finalized compliance policies and procedures relevant to your business operations. If applicable, please also provide copies of any final regulatory, insurer, or customer notices, inquiries, or allegations relating to potential violations of law or regulation within the past [X] years, along with a brief description of any remediation or corrective actions taken. Policies and Program Documentation Please provide the following policies, procedures, or program documentation, if applicable to your organization: Privacy Policy or Privacy Program documentation Complaint Management Policy and complaint log Compliance Training Policy or training materials Compliance Management System (CMS) documentation Vendor Risk Management Policy or program Corrective Action Policy or procedures Audit, Monitoring, and Testing Policy or procedures Customer-Facing Materials Please also provide any customer-facing scripts, disclosures, marketing materials, or other communications that may be used in connection with the services or relationship contemplated with Checkbook.
General Liability Insurance
*
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Please provide proof of general liability insurance in an amount commensurate with the risk involved in the conduct and operation of your business.
Financials
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Audited financial statements may be required for larger entities, while unaudited financials and tax returns are acceptable for small and mid-sized entities.
Signature
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Clear Signature
I certify all of the above information in this form are true and accurate.
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