XA Mobile

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Thank you for considering us for your financial services needs. We are sorry that we cannot continue with your application for the following reasons:

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We have cancelled your application.

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This account does not have sufficient balance to cover the total required deposit.

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Instant Account Verification

We offer a way to instantly verify your account information using . We only use this partner service to retrieve information required to transfer funds from your specified financial institution and to verify that your current balance is sufficient for this transaction.

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'Doing Business As' Information

DBA Business Information

Company Name

Business Tax ID Type

TIN

SSN

Business Tax ID

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Your Business Tax ID is used for identification purposes.

Your Social Security Number (SSN) is used for identification purposes and to determine your account opening eligibility.

Industry

Phone

(xxx) xxx-xxxx

DBA Physical Address

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Tell Us About Yourself

Personal Information

Suffix (Jr., Sr., etc.)

Date of Birth

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Address

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State

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Use different address for mailing

Mailing Address

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Zip

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State

Contact Information

Identification

ID Type

ID Number

ID State

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ID Date Issued

ID Expiration Date

About Your Employment

Employment Status

As the custodian for under the Virginia Uniform Transfers to Minor Act, I make this application on the minors

eSignature

Date:

Please upload the following documents in order that we can finish doing what we do.

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Additional Information

Are you, any of your immediate family members or close associates of a senior political (in the executive, legislative, administrative military or judicial branches) of the government?*

Since you answered yes to the above question. Please use the space below to let us know the Position and Country of the person who held the senior political position.

Do you have another applicant?

Yes

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Speed up your application process by taking the BACK image of your US driver's license.

If you do not wish to use this feature, simply close this popup window and proceed.

Recommendation for best recognition:

* Use a dark background

* Make sure all four corners are visible

* Avoid glare

* Make sure image is in focus

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Speed up your application process by taking the BACK image of your US driver's license.

If you do not wish to use this feature, simply close this popup window and proceed.

Recommendation for best recognition:

* Use a dark background

* Make sure all four corners are visible

* Avoid glare

* Make sure image is in focus

Done

System can't prefill due to ZIP code discrepancy. Please proceed by manually entering the information or correct the value in the ZIP field in the 1st page.

Tell Us About Yourself

Minor Information

Suffix (Jr., Sr., etc.)

Gender

Date of Birth

Mother's Maiden Name

Citizenship Status

Contact Information

Current Physical Address

Country

Address

Zip

City

State

Use different address for mailing

Mailing Address

Country

Address

Zip

City

State

Identification

ID Type

ID Number

ID State

ID Country

ID Date Issued

ID Expiration Date

Additional Information

Are you, any of your immediate family members or close associates of a senior political (in the executive, legislative, administrative military or judicial branches) of the government?*

Since you answered yes to the above question. Please use the space below to let us know the Position and Country of the person who held the senior political position.

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Fund via Internal Transfer

Fund via Credit Card

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Transfer from another financial institution

Co-Driver's License Scan

Driver's License Scan

New Membership

Application Cancelled

Funding

Fund via Internal Transfer

Fund via Credit Card

Alert Popup

Transfer from another financial institution

'Doing Business As' Information

Tell Us About Yourself

Co-Driver's License Scan

Driver's License Scan

Minor Applicant Information

Joint Applicant Information