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    
Agent
   
ADD
   
CHANGE
   
REMOVE
Other ________________
   
ADD
   
CHANGE
   
REMOVE



Joint Onwer(s) Information
   
 
   
CHANGE
   
 
POD Trust Beneficiary
   
ADD
   
CHANGE
   
REMOVE
Account Type/Services
   
ADD
   
CHANGE
   
REMOVE
OWNERSHIP INFORMATION CHANGES
 NAME (last - first - Initial)  MEMBER NUMBER
STREET  SOCIAL SECURITY NUMBER
CITY/STATE/ZIP DRIVER'S LICENSE NUMBER
HOME PHONE
     
   
   
LISTED
   
UNLISTED  
DATE OF BIRTH
PASSWORD
WORK PHONE
 EMPLOYMENT
EMAIL
 
The account(s) is a Joint Account
   
With Survivorship
   
Without Survivorship
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.
 NAME (last - first - Initial)  MEMBER NUMBER
STREET  SOCIAL SECURITY NUMBER
CITY/STATE/ZIP DRIVER'S LICENSE NUMBER
HOME PHONE
      
   
   
LISTED
   
UNLISTED  
DATE OF BIRTH
PASSWORD
WORK PHONE
 EMPLOYMENT
EMAIL
 
 NAME (last - first - Initial)  MEMBER NUMBER
STREET  SOCIAL SECURITY NUMBER
CITY/STATE/ZIP DRIVER'S LICENSE NUMBER
HOME PHONE


   
   
LISTED
   
UNLISTED  
DATE OF BIRTH
PASSWORD
WORK PHONE
 EMPLOYMENT
EMAIL
Account Designations
   
Payable on Death (POD)/Trust Account
   
All Accounts
   
Designate Specific Accounts
BENEFICIARY/POD PAYEE (last - first - Initial) BENEFICIARY/POD PAYEE
STREET STREET
CITY/STATE/ZIP CITY/STATE/ZIP
   
AGENCY PRINT NAME OF AGENT
Signature:
X__________________________________________________________________________________
  
                                                         
                                                                      Date
                                                                     
 
   
All Accounts
   
Designate Specific Account(s) ___________________________________
 
   
OTHER_________________________________________
   
See Account Authorization Card
Account Type Account Services
   
Share/Savings _______________________________
   
Overdraft Protection (indicate transfer priority below)
____________________________________________
   
Share Draft/Checking _________________________  
   
Money Market _______________________________
   
ATM Card ___________________________________
   
Share Certificate/Certificate ___________________
   
Debit Card ___________________________________
   
Other ______________________________________
   
Audio Response ______________________________
   
Other ______________________________________
   
PC Access/Internet Banking ____________________

 

 

 

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                                                         Date   Signature                                                                Date
X _________________________________________________ X _______________________________________________
  Signature                                                         Date   Signature                                                                Date
For Credit Union Use Only
    
   
See Account Authorization Card
   
See Insurance Benificiary Card
Date of Membership __________________ Opened/App'd by________________ hjhlMember Verification____________________
 
   
Credit Report  
   
Check Verify  
   
PIN Request
 
   
Access Card  
   
Audio Response  
   
PC Access/Internet Branching
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