Revisions to Notification of Bank Services Form

OMB Number: 3064-0029
Expiration Date: 06/30/2026

Federal Deposit Insurance Corporation

NOTIFICATION OF PERFORMANCE OF BANK SERVICES

PAPER REDUCTION ACT NOTICE
Public reporting for this collection of information is estimated to average 30 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the Paperwork Reduction Act Clearance Officer, Legal Division, Federal Deposit Insurance
Corporation, 550 17th Street, Washington, D.C. 20429, and the Office of Management and Budget, Paperwork Reduction Project
(3064-0029), Washington, D.C. 20503. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number.
Page down to access form 6120/06

FDIC 6120/06 (2-24)

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OMB Number: 3064-0029
Expiration Date: 06/30/2026

Federal Deposit Insurance Corporation

NOTIFICATION OF PERFORMANCE OF BANK SERVICES
SECTION I - FINANCIAL INSTITUTION INFORMATION
1. Financial Institution Name

2. Financial Institution Address (Street, City, State, ZIP Code)

SECTION II - REGIONAL DIRECTOR INFORMATION
3. Regional Director Name

4. Regional Director Mailing Address (Street, City, State, ZIP Code)
NOTE: Mail to the appropriate Regional Director (DCP) for your institution.
SECTION III - BANK SERVICES
In compliance with the requirement of the Bank Service Company Act, we hereby notify the Federal Deposit Insurance Corporation of
bank services provided by the servicer reported below.
5. Corporation Title of Servicer

6. Servicer's Corporate Headquarters Address (Street, City, State, ZIP Code)

7. Location of Premises Where Services Are Performed

8. Name of Managing Officer At Processing Location

9. Processing Location Telephone

10. Name of Principal Contact At Center (If other than Managing Officer)

11. Principal Contact Telephone

12. Application(s) Processed and Services Performed (Indicate both present and planned services.)

SECTION IV - AUTHORIZED OFFICER SIGNATURE
13. Title of Officer Authorized To Sign Notification

14. Telephone

15. Signature of Authorized Officer

16. Date

FDIC 6120/06 (2-24)

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