Change Of Address Form - Woodlands Bank
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1Change of Address Form
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Permanent/Home Address
Mailing/Alternate Address
Effective Date: __________
Customer’s Name(s):
1)
__________________________________ 2)_________________________________
Social Security Number(s): 1) _________________________________ 2) ________________________________
Previous Address:
____________________________________________________________________
____________________________________________________________________
New Address:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
County/Township:
____________________________________________________________________
Home Phone: 1) ______________________________________ 2) _____________________________________
Work Phone: 1) ______________________________________ 2) _____________________________________
Account Number(s) Affected: _____________________________________________________________________
Debit Card Number(s): 1) ___________________________________ 2) __________________________________
E-mail address:
1) ___________________________________ 2)__________________________________
Does either customer use internet banking? Please circle: Customer 1) Yes or No Customer 2) Yes or No
Does either customer use Woodlands Bank Bill Payer? Customer 1) Yes or No Customer 2) Yes or No
Please list any account number(s) for which new checks should be ordered: ________________________________
Does this change affect anyone else who has accounts with us? Please circle: Yes or No
If yes, please provide name(s): ____________________________________________________________________
________________________________________________________________ __________________________________________________________
Customer’s Signature *
nd
Customer’s Signature
Date
2
Date
Customer’s signature is also required if he/she uses his/her own ATM card or Internet Banking,
nd
* 2
or is a joint owner of Woodlands Financial Services Stock.
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ID Verified:
Photo ID
Signature
Other_____________________________
COPIES MADE
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Shareholder
County/Census Tract: ________________
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Changed By: _______________________________
Date: ___________________
Commercial
Loans
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Reviewed By: _______________________________
Date: ___________________
Consumer
Loans
Comments: ______________________________________________________________
REVISED 3/25/13
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Parent category: Legal