Fictitious Name Certificate

Date: _____________________

To: The Bancorp HSA

I hereby certify that the name ____________________ is registered under the ______________ Fictitious Name Act in the office of the Secretary of the Commonwealth on _________________________________.

Verified by: ______________________________________________

Checks, notes, drafts, acceptances, and orders for the payment of money when signed by an authorized signer, may be charged against this account until further notice.

Witness: _________________________________________________ 

Witness: _________________________________________________ 


For fast service you may fax this form to us at 302.385.5099. This form can also be mailed to:

The Bancorp HSA
409 Silverside Road, Suite 105
Wilmington, DE 19809

Banking Services provided by The Bancorp Bank. Member FDIC. Equal Housing Lender