CRB Account Application

Cannabis-Related Business Application

In order to process and open your cannabis-related business (CRB) account with Element, please provide all items listed below. Please contact us with any questions at 304canna@elementfcu.org.

Element CRB Account Application (click link below)

Account Application

CRB Questionnaire (included on page 2 of this form)

Government issued ID for ALL account Owners & Signers

Social security numbers for ALL account Owners & Signers

Your business license (issued from your state)

Your cannabis business license/permit (issued from your state)

List of all DBA (Doing Business As) names (if applicable)

IRS EIN (Employer Identification Number) letter

Corporate resolution, LLC agreement or other business document

Physical address associated with each cannabis business license

Full staff listing - Employee name, role, location of work

Complete cannabis application packet - this is the application packet you submitted to your state to obtain your licensing

Account application fee (Element will assess this fee on your first invoice after your account is verified and approved)

CRB Questionnaire

Your Business Name *

Date Business Established *

List ALL DBA Names (if applicable)

List Names of ALL Business Owners *

List Names of ALL Business Authorized Signers *

Products and Services you expect to utilize (check all that apply)

Checking Account

Savings Account

Online Banking Services

ATM/Debit Card

Wire Transfers

ACH Services

Are you planning any location changes in the next 12 months? If yes, please explain. *

Yes

No

Explain changes in next 12 months

Business Usage Expectations

List the total average dollar amounts you expect to receive in and pay out on a MONTHLY basis:

Cash deposits *

Cash withdrawals *

Check deposits *

Check withdrawals *

Incoming wires *

Outgoing wires *

ACH deposits *

ACH withdrawals *

Cole Memo Priorities

Does your business have procedures in place to:

Prevent the distribution of marijuana to minors? *

Yes

No

Prevent revenue from its sales to criminal enterprises, gangs, or cartels? *

Yes

No

Prevent the diversion of marijuana across state lines? *

Yes

No

Prevent state authorized activity from being used as a cover or pretext for the trafficking of other illegal drugs or other illegal activity? *

Yes

No

Prevent violence and use of firearms in the cultivation and distribution of marijuana? *

Yes

No

Prevent drugged driving and the exacerbation of other adverse public health consequences associate with marijuana use? *

Yes

No

Prevent growing marijuana on public lands and the attendant public safety and environmental dangers posed by marijuana production on public lands? *

Yes

No

Prevent marijuana possession or use on federal property? *

Yes

No

Ongoing Monitoring and Due Diligence

Ongoing monitoring of business activity by Element FCU is required under State/Federal regulations. Element FCU may do any of the following enhanced due diligence measures:

Ask you to complete an updated CRB Questionnaire periodically

Conduct site visits of your facilities

Request and review your written procedures for your business operations

Request and review written management and termination practices for your business operations

Request and review written employee screening practices for your business operations

Request and review QUARTERLY financial statement and state tax remittance forms

Acknowledgment and Certification

I hereby certify that I am an authorized representative of this Cannabis-Related Business and have the authority to enter into this agreement on its behalf.

I understand and acknowledge the following:

1. Service Limitations:

Element FCU reserves the right to limit or terminate services to this business at any time after account opening if it determines that any of the Cole Memo priorities listed on page 3 have been violated.

2. Ongoing Monitoring and Due Diligence:

I/we agree to provide all documentation and information requested by Element FCU as part of its ongoing monitoring and due diligence obligations.

3. Failure to Comply:

I understand that failure to comply with Element FCU’s requests for documentation or information may result in the suspension or closure of the account(s).

I confirm that I have read, understood, and agree to abide by the terms outlined above. *

Yes

No

Thank You