Account Change Application

Download the printable PDF form here.

SUBSEQUENT ACTIONS

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.)
Member/Owner Information   CHANGE  
Joint Owner(s) Information ADD CHANGE REMOVE
Agent ADD CHANGE REMOVE
POD/Trust Beneficiary ADD CHANGE REMOVE
Other ADD CHANGE REMOVE
Account Type Services ADD CHANGE REMOVE
   
OWNERSHIP INFORMATION CHANGES
   
Member/Owner
Member No.
Street
City/State/Zip
Home Phone
Listed Unlisted  
Work Phone
Email
Driver’s Lic. No.
Date of Birth
Password
Employment
   
The account(s) is a Joint Account
With Survivorship Without Survivorship
   
Joint owner: if required by the Credit Union, change 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 member share in the account(s) set forth on the reverse side. This relinquishment doe not affect my/our obligation on any loan accounts. All owners must sign.
   
Joint Owner
Street
City/State/Zip
Home Phone
Listed Unlisted  
Work Phone
Email
   
Driver’s Lic. No.
Date of Birth
Password
   
Joint Owner
Street
City/State/Zip
Home Phone
Listed Unlisted  
Work Phone
Email
   
Driver’s Lic. No.
Date of Birth
Password
   
ACCOUNT DESIGNATIONS
   
Payable on Death (POD)/Trust Account
Beneficiary/POD Payee
Street
City/State/Zip
   
Beneficiary/POD Payee
Street
City/State/Zip
   
Agency  
Name of Agency
Signature
Date
   
Other
See Account Authorization Card
   
ACCOUNT TYPE
   
Share/Savings
Share Draft/Checking
Money Market
Share Certificate
Other
Other
   
ACCOUNT SERVICES
   
Overdraft Protection (indicate transfer priority below)
 
ATM Card
Debit Card
Audio Response
PC Access/Internet Banking
   
AUTHORIZATION  
   
I/We agree that the changes on the 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, I/we agree to the terms of and acknowledge receipt of the Electronic Funds Transfer Agreement. Notice: the primary account holder cannot be changed. If you are adding a joint owner all other account holders are required to sign.
   
Signature Date
Signature Date
Signature Date
Signature Date
   
 

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