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13
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1
Name
First Name
Last Name
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2
Phone Number
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3
Email
example@example.com
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4
Bank Name
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5
Account Number
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6
9-Digit Routing Number
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7
Account Type
Checking
Savings
Other
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8
Terms and Conditions
*
This field is required.
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9
Signature
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10
Date Signed
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Date
Month
Day
Year
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11
Please verify that you are human
*
This field is required.
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12
Image Field
Setup a account with Chime if you do not have a bank account.
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13
Image Field
Setup a account with Netspend if you do not have a bank account.
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