@X00@X07@CLS@
       @X10┌───────────────────────────────────────────────────────────────@X19┐@X07
       @X10│  @X19┌─────────────────────────────────────────────────────────@X10┐  @X19│@X07
       @X10│  @X19│   @X1FBy supplying us with either your drivers license #    @X10│  @X19│@X07
       @X10│  @X19│   @X1For social security number, you are securing this      @X10│  @X19│@X07
       @X10│  @X19│   @X1Ftransaction and agreeing that:                        @X10│  @X19│@X07
       @X10│  @X19│                                                         @X10│  @X19│@X07
       @X10│  @X19│     @X1C1 - @X1EThis is your account.                           @X10│  @X19│@X07
       @X10│  @X19│     @X1C2 - @X1EYou are initiating this transaction.            @X10│  @X19│@X07
       @X10│  @X19│     @X1C3 - @X1EYou are requesting your bank to honor this      @X10│  @X19│@X07
       @X10│  @X19│         @X1Etransaction as you have entered it.             @X10│  @X19│@X07
       @X10│  @X19│     @X1C4 - @X1EYou are at least 18 years of age.               @X10│  @X19│@X07
       @X10│  @X19└@X10─────────────────────────────────────────────────────────┘  @X19│@X07
       @X10└@X19───────────────────────────────────────────────────────────────┘@X07@XFF