VENDOR FORMS PROTECTED BY COPYRIGHT As a reminder, most forms produced by vendors are covered by copyright. This includes forms produced by Financial Institution Products Corporation (FIPCO). Reproduction of a form protected by copyright, by any means or method, is a violation of law unless the form producer holding the copyright provides express permission for the form to be reproduced. In order to maintain the protections copyright affords, violations are pursued by the form producer and can be quite costly to the person or entity committing the violation. Thus, users of forms must not reproduce forms by any means unless permitted to do so by the producer of the form.
Updated 6/29/2018 Financial Institution Products Corporation WBA Hard Copy and Electronic Forms STATUS SHEET AND HARD COPY ORDER FORM Hard Copy forms must be ordered in multiples of 20* *must be of the same form - cannot combine forms Please order by qty of forms needed, not packages Forms packaged in 100 s unless otherwise noted KEY 4 Indicates the form is currently in revision. Not available electronically (availability subject to change) To order hard copy forms by fax or email, complete the information below and make your selections on the proceeding pages. FAX: 608.661.9382 EMAIL: fipcosales@fipco.com COMPANY NAME CUSTOMER # WBA MEMBER? n YES n NO CONTACT NAME PHONE # FAX # EMAIL STREET ADDRESS CITY STATE ZIP More ordering options: Order Hard Copy forms online: www.fipco.com/hcorder email: fipcosales@fipco.com phone: 800.722.3498 License Electronic forms by contacting our Forms Department: email: fipcoforms@fipco.com phone: 800.722.3498, ext. 236 WBA FORMS ARE SOLD ON AN AS IS BASIS. SELLER MAKES NO REPRESENTATIONS, WARRANTIES, OR GUARANTEES, EXPRESS, IMPLIED, OR STATUTORY, INCLUDING WITHOUT LIMITATION ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR INTENDED USE FOR ANY PARTICULAR PURPOSE.
(Forms are listed numerically by WBA # and grouped according to type.) updated 6/29/2018 WISCONSIN CONSUMER LENDING FORMS (11001) WBA (TL) 1 7/13 Federal Truth In Lending Loan (11882) WBA (TL) 2-HE 8/15 Acquirer's Notice Regarding Assignment, Sale Or Transfer Of Your Home Equity Line of Credit Mortgage Loan (11230) WBA (TL) 3A 12/96 Notice of right to cancel (for security interest in consumer s principal (11011) WBA (TL) 4 cons 1/79 Deferral - 4 part (11312) WBA (TL) 4S 6/99 Simple interest deferral (11010) WBA 4 12/14 Assignment of Life Insurance Policy As Collateral (11012) WBA 4A 1968 Release of Assignment of Life Insurance Policies (11031) WBA 127 5/13 Financial statement - individual (11034) WBA 130 8/14 General credit application & financial statement MODEL (11874) WBA 141 9/07 Covered Borrower Identification Stmnt MODEL (11875) WBA 142 9/07 Consumer Credit Disclosures Under the National Defense Authorization Act 4 (11042) WBA 151 11/16 Continuing guaranty (unlimited) 4 (11043) WBA 152 12/16 Guaranty of specific transaction 4 (11044) WBA 153 11/16 Continuing guaranty (limited) (11284) WBA 154 12/03 Spousal consent (11349) WBA 154A 12/03 Spousal consent to UCC filing (11285) WBA 155 9/14 Marital purpose statement (11045) WBA 156 cons 8/98 Explanation of co-signer obligation (do not use for open-end accounts) (11046) WBA 158 7/99 Notice of collateral pledge of deposit account or investment (11053) WBA 190 2/08 Collateral info on life insurance policy (11065) WBA 238 bus/con 8/13 Real estate security (11883) WBA 252 3/10 Statement of Fees and Charges (11129) WBA 410 cons 6/13 Consumer chattel security (11136) WBA 420 busn 6/03 Consumer & business to deliver collateral (11138) WBA 421 cons 5/13 Consumer collateral pledge agrmt. (11140) WBA (UCC) 423 4/07 Collateral register 4 (11146) WBA 430S cons 5/13 Simple interest consumer installment sale and security For detailed information regarding the #11149 and #11898 visit: www.fipco.com/revised (11149) WBA 431S cons 1/18 FEES PREFILLED Motor Vehicle Cons. Simple Interest Installment Sale & Security Agreement (11898) WBA 431S(B) cons 1/18 FEES NOT PREFILLED Motor Vehicle Cons. Simple Interest Installment Sale & Security Agreement (11151) WBA 432A 8/99 Homeowners certificate (11188) WBA 433S cons 6/08 Consumer simple interest installment sale unsecured (11224) WBA 436 cons 11/16 Motor vehicle lease 4 (11314) WBA 457 3/14 Home equity credit (11175) WBA 458 1/15 Mortgage note (11176) WBA (UCC) 460 1/07 Fixture disclaimer (11178) WBA 470 cons 4/07 Notice of right to cure default (11833) WBA 470 MV cons 11/08 Notice of right to cure default and of Creditor s Right to Repossession of Motor Vehicle (11834) WBA 471 cons 1/09 Notice to Borrower Prior to Repossession of Motor Vehicle (11179) WBA 474 cons 4/07 Notice of surrender of collateral COMMERCIAL FORMS (11013) WBA (TL) 5 7/99 Truth-in-lending declaration of business purpose (11010) WBA 4 12/14 Assignment of Life Insurance Policy As Collateral (11012) WBA 4A 1968 Release of Assignment of Life Insurance Policies 4 (11017) WBA 75 7/10 Depository declaration (11318) WBA 84B 11/07 Declaration of Trust Ownership by Successor Trustee (11241) WBA (L/C) 100 3/14 Application for standby letter of credit (11829) WBA (L/C) 100A 11/13 Application for Amendment to Standby letter of credit (11244) WBA (L/C) 103 4/07 Irrevocable standby letter of credit (11831) WBA (L/C) 103A 4/07 Amendment to Irrevocable Standby letter of credit (11830) WBA (L/C) 103 LTR 9/06 Acceptance or Refusal Form (11245) WBA (L/C) 104 10/06 Letter of credit (11031) WBA 127 5/13 Financial statement - individual (11034) WBA 130 8/14 General credit application and financial statement (11257) WBA 130S 5/14 Short form credit application (11336) WBA 140 8/03 Customer Identification & Verification 4 (11914) WBA 140A busn 2/17 General Instructions Certification and Beneficial Owner(s) 4 (11914) WBA 140B busn 4/17 Certification of No Change in Prior...Certification 4 (11041) WBA 150 busn 8/06 Debt subordination 4 (11042) WBA 151 11/16 Continuing guaranty (unlimited) 4 (11350) WBA 151B 11/16 Busn. Continuing guaranty (Unlimited) 4 (11043) WBA 152 12/16 Guaranty of specific transaction 4 (11351) WBA 152B 5/16 Busn. Guaranty of Specific Transaction 4 (11044) WBA 153 11/16 Continuing guaranty (limited) 4 (11352) WBA 153B 11/16 Busn. Continuing guaranty (limited) (11284) WBA 154 12/03 Spousal consent (11349) WBA 154A 12/03 Spousal consent to UCC filing (11285) WBA 155 9/14 Marital purpose statement (11046) WBA 158 7/99 Notice of collateral pledge of deposit account or investment (11050) WBA 187 3/15 Corporate resolution for borrowing and Pledging assets (11174) WBA 187LLC 3/15 Limited liability company borrowing (11051) WBA 188 3/15 Organization borrowing resolution (11053) WBA 190 2/08 Collateral information on life Ins. policy (11343) WBA 232 3/04 Release of Assignment of Lease & Rents - by Lender (11063) WBA 233 7/04 Satisfaction of real estate mortgage by lender (11065) WBA 238 bus/con 8/13 Real estate security s (11016) WBA 402A (ECOA) 4/13 Credit denial with reasons (11039) WBA 402B 4/13 Credit denial notice of rights (11002) WBA 402C 4/13 Credit denial w/o reasons (11128) WBA 410 busn 2/16 Chattel security (11136) WBA 420 bus/con 6/03 Consumer & business to deliver collateral (11137) WBA 421 busn 5/13 Business collateral pledge (11322) WBA 421 DACA 5/08 Deposit account control &... General Terms (11140) WBA (UCC) 423 4/07 Collateral register (11113) WBA 425 4/16 Assignment of mortgage by lender 4 (11142) WBA 428 12/16 Real estate mortgage (11429) WBA 428B 12/16 Real Estate mortgage (11353) WBA 428N 8/04 Notice of mortgage 4 (11222) WBA 428G 12/16 Real estate mortgage to secure grnty (11225) WBA 436 busn 8/98 Motor vehicle lease 4 (11157) WBA 444 busn 2/16 Selective business security 4 (11159) WBA 447 busn 2/16 General business security (11709) WBA 448RT 7/17 Revolving & Term Credit Agreement (11867) WBA 448CL bus 7/17 Construction Loan Agreement (11869) WBA 448CLN bus 3/15 Construction Loan Promissory Note (11906) WBA 448 Unsecured 7/14 Business Credit Agrmnt (Unsecured) (11160) WBA 449 busn 2/13 Loan participation certificate and agmn (11221) WBA 451 busn 3/15 Business note (11176) WBA UCC 460 1/07 Fixture disclaimer (11177) WBA 461 4/92 Security interest subordination agrmnt MODEL (11528) PDF 1832 12/01 Special Form of Assignment for U.S. Registered Definitive Securities (OMB No. 1535-0059) REAL ESTATE FORMS Booklets sold in multiples of 50 (11508) CFPB CHARM BOOKLET 1/2014 Consumer Handbook on Adjustable Rate Mortgages (11516) NEW CFPB Your Home Loan Tool Booklet Start Using 10/3/2015 (11527) CFPB HELOC Booklet 1/2014 Home Equity Lines of Credit - What You Should Know About Order these booklets online at: www.fipco.com/booklets (11882) WBA (TL) 2-HE 8/15 Acquirer's Notice Regarding Assignment, Sale Or Transfer Of Your Home Equity Line of Credit Mortgage Loan (11230) WBA (TL) 3A 12/96 Notice of right to cancel (for security interest in consumer s principal dwelling under closed end credit) (11312) WBA (TL) 4S 6/99 Simple Interest Deferral Agreement (11318) WBA 84B 11/07 Declaration of Trust Ownership by Successor Trustee (11174) WBA 187LLC 3/15 Limited Liability Company Borrowing Agreement (11051) WBA 188 3/15 Organization Borrowing Resolution (11062) WBA 231 6/99 Partial release of real estate mortgage (11343) WBA 232 3/04 Release of Assignment of Lease & Rents by Lender (11063) WBA 233 7/04 Satisfaction of real estate mortgage by lender (11320) WBA 237 9/13 Assignment of land contract (11065) WBA 238 bus/con 8/13 Real estate security (11212) WBA (RESPA) 240F 6/95 Initial escrow account disclosure statement (11883) WBA 252 3/10 Statement of Fees and Charges (11113) WBA 425 4/16 Assignment of mortgage (11273) WBA 426 10/17 Agreement for subordination of future advances 4 (11142) WBA 428 12/16 R.E. mortgage (11429) WBA 428B 12/16 R.E. mortgage (11353) WBA 428N 8/04 Notice of mortgage 4 (11222) WBA 428G 12/16 Real Estate Mortgage to Secure...Guaranty (11143) WBA 429 11/13 R.E. mortgage subordination WBA FORMS ARE SOLD ON AN AS IS BASIS. SELLER MAKES NO REPRESENTATIONS, WARRANTIES, OR GUARANTEES, EXPRESS, IMPLIED, OR STATUTORY, INCLUDING WITHOUT LIMITATION ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR INTENDED USE FOR ANY PARTICULAR PURPOSE.
updated 6/29/2018 4 (11314) WBA 457 3/14 Home equity credit (11175) WBA 458 1/15 Mortgage note (11607) (PMI) 507 6/99 PMI annual disclosure (11401) WCC 11401 11/93 Disbursement (11402) WCC 11402 11/93 General contractor s disbursement control affidavit (11403) WCC 11403 11/93 General contractor s draw request (11404) WCC 11404 11/93 Owner s authorization of draw (11405) WCC 11405 2/94 Change order SAFE DEPOSIT BOX FORMS (11073) WBA 270 (25) 9/09 Natural person safe deposit box lease (5 x 8-2 part) (11183) WBA 270 (24) 9/09 Natural person safe deposit box lease (4 x 6-2 part) 4 (11074) WBA 271(25) 9/09 Fiduciary safe deposit box lease (5 x 8-2 part) 4 (11184) WBA 271 (24) 9/09 Fiduciary safe deposit box lease (4 x 6-2 part) (11075) WBA 272 (25) 9/09 Organization or partnership safe deposit box lease (5 x 8-2 part) (11185) WBA 272 (24) 9/09 Organization or partnership safe deposit box lease (4 x 6-2 part) (11077) WBA 274 9/94 Safe deposit declaration (11078) WBA 275 8/94 Certificate of authorized persons & signature for safe deposit box (8 1/2 x 11-3 part) (11186) WBA 275 (34) 8/94 Certificate of authorized persons & signature for safe deposit box (4 x 6-3 part) (11079) WBA 278 4/14 Designation of agent by natural (11281) WBA 278 (34) 7/13 Designation of agent by natural (4 x 6-3 part) (11282) WBA 278 (35) 7/13 Designation of agent by natural (5 x 8-3 part) (11080) WBA 279 4/14 Single access designation of agent by natural person lessee(s) for safe deposit box (11081) WBA 280 11/78 Natural persons safe deposit entry record (11082) WBA 281 11/78 Organization/partnership/fiduciaries safe deposit entry record 11083 (11083) WBA 283 11/78 Safe deposit access ticket (11085) WBA 285 11/78 Rent record for safe deposit box (11086) WBA 287 9/03 Notice of safe deposit box rent due (11087) WBA 288 6/95 Termination of lease and notice of intent to forcibly open safe deposit box for non-payment of rent (11088) WBA 289 7/95 Record of examination of safe deposit box contents (11089) WBA 290 6/95 Document receipt (11090) WBA 292 10/11 Affidavit for safe deposit box key found and destroyed (11091) WBA 293 6/95 Affidavit for safe deposit box key found and NOT destroyed (11092) WBA 294 6/95 Affidavit of contents of safe deposit box opened by bank (11093) WBA 295 11/78 Safe deposit box history & numerical cross index to lessee (11094) WBA 296 6/95 Receipt & release for property removal after death (11095) WBA 297 12/91 Safekeeping MUNICIPAL FORMS 4 (11024) WBA 100 3/02 Resolution designating public - municipal accounts 4 (11025) WBA 101 (33) 3/02 Public acct. signature card - municipal accounts - 3 x 5 4 (11026) WBA 101 (34) 3/02 Public acct. signature card - municipal accounts - 4 x 6 (11027) WBA 102 3/02 Resolution designating public - misc. public accounts (11028) WBA 103 (33) 3/02 Public acct. signature card - misc. public accounts - 3 x 5 (11029) WBA 103 (34) 3/02 Public acct. signature card - misc. public accounts - 4 x 6 (11248) WBA 104 8/11 Public deposits security (11249) WBA 104A 7/00 Collateral register and notice (11252) WBA 105 7/00 Public deposits control (11255) WBA 106 9/11 Notice of substitution of collateral (11256) WBA 107 3/02 Amended resolution designating public (11054) WBA 194 8/06 Resolution for temp. borrowing by school district (11055) WBA 199 8/06 Resolution for temp. municipal borrowing 4 (11056) WBA 200 8/06 City borrowing on notes maturing up to 10 years 4 (11057) WBA 201 8/06 Sanitary district borrowing on notes maturing up to 10 years 4 (11058) WBA 202 8/06 School district borrowing on notes maturing up to 10 years 4 (11059) WBA 203 8/06 Village borrowing on notes maturing up to 10 years 4 (11060) WBA 204 8/06 Town borrowing on notes maturing up to 10 years 4 (11061) WBA 205 8/06 County borrowing on notes maturing up to 10 years 4 (11325) WBA 220 8/06 City borrowing on notes maturing within 10 years-term credit 4 (11326) WBA 221 8/06 Sanitary district borrowing on notes maturing within 10 years-term credit 4 (11327) WBA 222 8/06 School district borrowing on notes maturing within 10 years-term credit 4 (11328) WBA 223 8/06 Village borrowing on notes maturing within 10 years-term credit 4 (11329) WBA 224 8/06 Town borrowing on notes maturing within 10 years-term credit 4 (11330) WBA 225 8/06 County borrowing on notes maturing within 10 years-term credit AGRICULTURAL FORMS (11312) WBA (TL) 4S 6/99 Simple Interest Deferral Agreement (11209) WBA (TL) 6 12/92 Declaration of agricultural purpose (11033) WBA 129 7/14 Financial statement - rural 4 (11197) WBA 711 11/14 Farm security (11277) WBA 711A 12/96 Farm products notice (11099) WBA 711B 10/07 List of authorized buyers (11210) WBA 712 8/06 Notice of assignment of farm products (11202) WBA 713 5/01 Farm auction note and security agrmnt (11290) WBA 730S 5/01 Agricultural simple interest installment sale and security (11198) WBA 753 5/01 Agricultural installment note & chattel security FCRA FORMS (11288) WBA (FCRA) 604(B)(2) 8/97 Disclosure regarding use of consumer report for employment purposes (11291) WBA (FCRA) 1-615(a) 8/11 Notice of Adverse Action in Noncredit Transaction Based on Cons Report (11182) WBA (FCRA)(ECOA) 616 4/13 Credit denial w/ Reason MODEL FORMS MODEL (11874) WBA 141 9/07 Covered Borrower Identification Stmnt MODEL (11875) WBA 142 9/07 Consumer Credit Disclosures Under the National Defense Authorization Act MODEL WBA (FCRA) 604(b)(3) 8/97 Notice of use of Consumer Report for Employment Purposes MODEL WBA (FCRA) 1-606(a)(1) 8/97 Disclosure Regarding an Investigative Consumer Report MODEL WBA (FCRA) 2-606(b) 7/97 Disclosure of Nature and Scope of Investigative Report MODEL WBA (FCRA) 1-615(b) 8/97 Disclosure of Nature of Information from a Third Party other than a CRA MODEL (11528) PDF 1832 12/01 Special Form of Assignment for U.S. Registered Definitive Securities (OMB No. 1535-0059) DEPOSIT & OPERATIONS FORMS (11131) WBA 3 2/10 Revocation of preauthorized payments 4 (11017) WBA 75 7/10 Depository Declaration (11133) WBA 84 4/14 Declaration of trustee designating (11163) WBA 84A 8/14 Declaration of trustee borrowing authority (11318) WBA 84B 11/07 Declaration of trust ownership by successor trustee (11021) WBA 91 (13) 6/15 Organization account designation (3 x 5; single part) (11096) WBA 91 (33) 6/15 Organization account designation (3 x 5; 3-part) (11023) WBA 93 12/96 Stop payment order 4 (11024) WBA 100 3/02 Resolution designating public and authorizing withdrawal of county, city, village or school district moneys 4 (11025) WBA 101 (33) 3/02 Public account signature card - municipal accounts - 3 x 5 4 (11026) WBA 101 (34) 3/02 Public account signature card - municipal accounts - 4 x 6 (11027) WBA 102 3/02 Resolution designating public - for misc. public accounts (11028) WBA 103 (33) 3/02 Public account signature card - misc. public accounts - 3 x 5 (11029) WBA 103 (34) 3/02 Public account signature card - misc. public accounts - 4 x 6 (11248) WBA 104 8/11 Public deposits security (11249) WBA 104A 7/00 Collateral register (11252) WBA 105 7/00 Public deposits control (11255) WBA 106 9/11 Notice of substitution of collateral (11256) WBA 107 3/02 Amended resolution designating public (11095) WBA 297 12/91 Safekeeping (11097) WBA 309 9/91 Bond of indemnity for lost documents (11226) WBA 310 1/97 Declaration of loss 4 (11711) WBA 312 4/16 Overdraft Transfer (11098) WBA 350 4/06 Application for employment (11207) WBA 350A 3/14 Voluntary Self Identification - Applicants (11795) WBA 350B 3/14 Voluntary Self Identification - Employee (11910) WBA 350C 6/18 Voluntary Self Identification of Disability (11108) WBA 364 12/05 Night Depository Agreement (11115) WBA 380 (13) 3/15 Account designation signature card (3 x 5; single part) (11117) WBA 380 (33) 3/15 Account designation signature card (3 x 5; 3 part)
(11119) WBA 381 (13) 4/14 Agent (power of attorney) designation signature card - 3 x 5 single part (11120) WBA 381 (14) 4/14 Agent (power of attorney) designation signature card - 4 x 6 single part (11121) WBA 381 (33) 4/14 Agent (power of attorney) designation signature card (3 x 5; 3 part) (11122) WBA 381 (34) 4/14 Agent (power of attorney) designation signature card - 4 x 6 3 part (11123) WBA 382 (1) 3/18 P.O.D. beneficiary designation 1-part (11124) WBA 382 (3) 3/18 P.O.D. beneficiary designation - 3 part (11125) WBA 383 (1) 3/07 Claim form for P.O.D. account - 1-part (11126) WBA 383 (3) 3/07 Claim form for P.O.D. account - 3 part CUSTOM (11101) WBA 384 11/16 Deposit account rules Note: This is a standard set of rules customized for each financial institution. Call FIPCO for the questionnaire which will allow us to print these rules to your specifications. (11102) WBA 386 9/17 Wire transfer (11431) WBA 386A 1/05 Wire transfer Request Form (11135) WBA 387 and 387A 7/17 Repurchase (11199) WBA 387B 7/17 Repurchase confirmation notice (11892) WBA 389 8/10 Agent s Certification As to the Validity of Power of Attorney for Finances and Property and Agent s Authority (11432) WBA 390 6/15 Designation of Successor Custodian Under Wisconsin Uniform Transfers to Minors Act (11304) WBA 391 C-13 8/88 Exception hold notice (11305) WBA 391 C-13A 8/88 Reasonable cause hold notice (11191) WBA 391 C-13B 1/10 Notice of hold (11193) WBA 391 C-13C 1/10 Notice of hold (11306) WBA 392 C-14 8/88 Case by case hold notice FNMA/FHLMC FORMS updated 6/29/18 MISCELLANEOUS FORMS (11807) State Bar of Wisconsin 12/94 Waiver of Construction Lien SAFETY PAPER & SIGNATURE CARD STOCK Sold in multiples of 100 FL 201 3 x 5 signature card stock for laser printers FL 202 4 x 6 signature card stock for laser printers FL 203 8 1/2 x 11 blue safety paper for laser generated certificates of deposit FL 204 8 1/2 x 11 green safety paper for laser generated certificates of deposit FL 223 3 x 5 signature card stock (pink) FL 224 4 x 6 signature card stock (pink) FL 246 8 1/2 x 11 Buff (canary) safety paper for laser generated certificates of deposit Order safety paper and card stock online at: www.fipco.com/paper THUMBPRINT SIGNATURE SUPPLIES S106 Black Ink Pads (Minimum of 10) S107 Counter Displays S108 Decals S109 Statement Stuffers (Minimum of 500) Order thumbprint signature supplies online at: www.fipco.com/thumbprint DIRECTORY FD100 Wisconsin Financial Institution s Directory Order Wisconsin Financial Institution s Directory online at: www.fipco.com/fdorder COIN & CURRENCY SUPPLIES Preformed coin wrappers, currency straps, coin wrappers and more Order your Coin & Currency Supplies online at www.fipco.com/currency CUSTOM PRODUCTS (CALL EXT 274 OR EMAIL fipcosales@fipco.com FOR THE PRODUCTS BELOW) Cash Tickets (Single Ply, Duplicate, Fold-Over) Checks (Cashier s, BMO & PMO, Expense, Custom) Teller Supplies (Receipts, Savings Deposits, etc.) GL Debits & Credits Other Products also available