A person establishing an account under this section shall sign a statement containing language substantially similar to the following in a conspicuous manner:
"SAVINGS AND LOAN (or name of institution)
PERSONAL AGENCY ACCOUNT
G.S. 54B-139
I understand that by establishing a personal agency account under the provisions of North Carolina General Statute 54B-139 that 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. § 54B-139