EPB EMPLOYEES CREDIT UNION - Home
Address Change Request Form
One Form Per Member
As a convenience, we are providing this form on-line to expedite your desire to change the address of record. We are required to have written authorization from you permanently on file. Please take a moment to type in the necessary information below. Once completed, please sign and date this form and FAX, mail, or bring in as soon as possible. Each member having his/her own membership account (unless a minor less than 18 years of age) must sign a form, even if several members have the same address.
Name: Member Account:
Email:_____________________________________________ Phone #:
I have the following account types: For Credit Union Use
[ ] Shares/Savings/CDs/Loans [______] CUSA
[ ] Draft/Checking [______] Main Street, Inc
[ ] Visa Debit Card [______] Fiserv EFT
[ ] MasterCard Credit Card [______] FIS
[ ] Visa Credit Card [______] Virtual Branch
I request that EPB Employees Credit Union change my address of record:
Old Address New Address
_____________________________________ ______________________________________
_____________________________________ ______________________________________
If your new address is a P O Box, you must include a physical address:
Member’s Signature: _____________________________________ Date: __________________
In accordance with the Internal Control Policy and the Information Security Program, the following form is used to document and/or authorize changes to members’ accounts. This form will be reviewed by Management, Supervisory/ Audit Committee, Independent Auditors and State Examiners to verify compliance and authenticity.
For Credit Union Use: Checked off Member Audit Report (M601) and filed in Membership File. _______________
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