| ACCOUNT CHANGE FORM |
| SUBSEQUENT ACTIONS |
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I/We authorize the Credit Union to make and accept the following changes to my/our accounts:
TYPE OF CHANGE (Please indicate the type of change and complete only the information that affects the change.)
| Account/Owner Information |
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CHANGE |
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| Agent |
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ADD |
|
CHANGE |
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REMOVE |
| Trustee ________________ |
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ADD |
|
CHANGE |
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REMOVE |
| Joint Onwer(s) Information |
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CHANGE |
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| POD Trust Beneficiary |
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ADD |
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CHANGE |
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REMOVE |
| Account Type/Services |
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ADD |
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CHANGE |
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REMOVE |
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| OWNERSHIP INFORMATION CHANGES |
| MEMBER/OWNER |
ACCOUNT NUMBER |
| STREET |
SSN/TIN |
| CITY/STATE/ZIP |
DRIVER'S LICENSE NUMBER |
HOME PHONE
( DFGDG )) )) |
| |
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LISTED |
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UNLISTED |
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DATE OF BIRTH |
| PASSWORD |
WORK PHONE
(KSDFKSDJF) |
EMPLOYMENT |
| EMAIL |
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| |
| The account(s) is a Joint Account |
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With Survivorship |
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Without Survivorship |
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| JOIN OWNER: If required by the Credit Union, removel of a Joint Account Owner requires consent of all owners, and we will hold Credit Union harmless for actions regarding account access. The removed joint account owner(s) relinquishes ownership interest including any membership share in the account(s) set forth below. This relinquishment does not affect my/our obligation on any loan accounts. |
| JOINT OWNER |
SSN/TIN |
| STREET |
DRIVER'S LICENSE NUMBER |
| CITY/STATE/ZIP |
DATE OF BIRTH |
HOME PHONE
(KSDFKSDJF) |
PASSWORD |
WORK PHONE
(KSDFKSDJF) |
EMAIL |
|
|
|
| |
| JOINT OWNER |
SSN/TIN |
| STREET |
DRIVER'S LICENSE NUMBER |
| CITY/STATE/ZIP |
DATE OF BIRTH |
HOME PHONE
(KSDFKSDJF) |
PASWORD |
WORK PHONE
(KSDFKSDJF) |
EMAIL |
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| Account Designations |
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Payable on Death (POD)/Trust Account |
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All Accounts |
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Designate Specific Accounts |
| BENEFICIARY/POD PAYEE (last - first - Initial) |
BENEFICIARY/POD PAYEE |
| STREET |
STREET |
| CITY/STATE/ZIP |
CITY/STATE/ZIP |
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|
AGENCY |
PRINT NAME OF AGENT
|
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Signature:
X__________________________________________________________________________________
sgfdhgfjhgfhkjhljk;lk;l;';lk'dgfldkagjslklj'Date
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All Accounts |
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Designate Specific Account(s) ___________________________________ |
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OTHER_________________________________________ |
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See Account Authorization Card |
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| Account Type |
Account Services |
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Share/Savings _______________________________ |
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Overdraft Protection (indicate transfer priority below)
____________________________________________ |
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Share Draft/Checking _________________________ |
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Money Market _______________________________ |
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ATM Card ___________________________________ |
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Share Certificate/Certificate ___________________ |
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Debit Card ___________________________________ |
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Other ______________________________________ |
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Audio Response ______________________________ |
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Other ______________________________________ |
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PC Access/Internet Banking ____________________ |
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| I/We agree that the changes on this Card amend the previously signed Account Card and are subject to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Disclosure, and Funds Availability Policy Disclosure, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein. I/We acknowledge receipt of a copy of the Agreements and Disclosures applicable to the accounts and services requested above. If an access card or EFT service is requested and provided,m I/we agree to the terms of and acknoledge receipt of the Electronic Funds Transfer Agreement. |
| X |
_________________________________________________ |
X |
_______________________________________________ |
| |
Signature ksdfkdsjfdfdhf dfgkj Date |
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Signature sdfkdsjflksjfdfdfkdf Date |
| X |
_________________________________________________ |
X |
_______________________________________________ |
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Signature ksdfkdsjfdfdhf dfgkj Date |
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Signature sdfkdsjflksjfdfdfkdf Date |
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| For Credit Union Use Only |
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See Account Authorization Card |
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See Insurance Benificiary Card |
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| Date of Membership __________________ |
Opened/App'd by________________ |
hjhlMember Verification____________________ |
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Credit Report |
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Check Verify |
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PIN Request |
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Access Card |
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Audio Response |
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PC Access/Internet Branching |
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You Must Print, Sign, and Return to Credit Union
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