Form 4789: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin with Part I, where you will need to provide the identity of the individual conducting the transaction. Fill in their last name, first name, middle initial, and social security number.
Complete the address fields including street number, city, state, and ZIP code. Ensure that you include a valid occupation for the individual.
In Item 14, enter the date of birth in MM/DD/YY format. For verification methods in Item 15, describe how you verified their identity.
If applicable, check Box 2 for multiple individuals involved and complete additional information on the back of the form.
Proceed to Part II if the transaction was conducted on behalf of another person. Fill out their details as required.
In Part III, indicate any accounts affected by this transaction by checking appropriate boxes and entering account numbers.
Finally, review all entries for accuracy before submitting your completed form through our platform.

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