Request for Additional Information

Request for Additional Information MSUE Bank Balances – June 30, 2017

County Name: Click here to enter text. Contact person: Click here to enter text. Email & phone: Click here to enter text.

1- Please provide a list of names/individuals of who is authorized to sign on your MSUE accounts. If you have multiple accounts, please provide information for each account.

Account number: Click here to enter text. Type of account (ie. Checking, CD, Share, etc.): Click here to enter text. Authorized staff able to sign on MSUE account listed above (list names): Click here to enter text.

☐ Check box, if it does not apply.

2- Please provide a list of credit cards used in conjunction with the county bank accounts: (e.g., VISA, MasterCard, store name such as Sam’s Club….). This does not include a request for MSU purchasing card information.

Credit card name: Click here to enter text. Credit card account number: Click here to enter text. Authorized MSUE staff to use credit card (list names): Click here to enter text.

☐Check box, if it does not apply. We do not have credit cards associated with the MSUE bank accounts.

3- Please provide information regarding store lines of credit: (e.g., ACE, True Value, Glen’s Market, IGA….)

Name of business: Click here to enter text. Store line of credit account number (if applicable): Click here to enter text. Authorized MSUE staff to use store line of credit (list names): Click here to enter text.

☐Check box, if it does not apply. We do not have any store lines of credit associated with the MSUE bank accounts.

Please use additional pages if you have more information to report. Thank you!