A person establishing an account under this section shall sign a statement containing language substantially similar to the following in a conspicuous manner:
"SAVINGS BANK (or name of institution)
PERSONAL AGENCY ACCOUNT
G.S. 54C-167
I understand that, by establishing a personal agency account under G.S. 54C-167, the agent named in the account may:
I also understand that upon my death the money remaining in the account will be controlled by my will or inherited by my heirs.
______________________"
N.C. Gen. Stat. § 54C-167