Membership Change Card Form printable pdf download

MEMBERSHIP C HANGE C ARD

Member N ame_________________________________________ Account N umber______________________

SUBSEQUENT A CTIONS

I/We a uthorize t he C redit U nion t o m ake a nd a ccept t he f ollowing c hanges t o m y/our a ccounts:

Add A ccount(s):

! S hare D raft C hecking

Add P roduct(s): ! V isa C heck C ard

! M oney M arket

! F lightline/Mobile B anking/TARA

! S ub S aving

PERSONAL A CCOUNTS

Add J oint O wner

-‐ A dd t he f ollowing j oint o wner(s) o n t he f ollowing:

[Note: Y ou c annot a dd a j oint o wner t o a t rust a ccount]

! A ll S hare A ccounts o r ! D esignate S pecific A ccounts: _ _________ _ _________ _ _________ _ _________

Joint O wner N ame _ ____________________________

Joint O wner P rimary # _ ______________________

Address _ _________________________________

SSN/TIN _ _______________________________________

_________________________________________

ID#_________________ S T/Ctry _ _______ E xp _ ________

Date o f B irth _ ____________ H ome P hone _ _____________Work _ _______________ C ell _ _______________

Email _ ______________________ C ode W ord/Place o f B irth_________________________________________

Employer/Job T itle o r P osition _ _____________________________ R elation t o O wner _ ___________________

Joint O wner N ame _ ____________________________

Joint O wner P rimary # _ ______________________

Address _ _________________________________

SSN/TIN _ _______________________________________

_________________________________________

ID#_________________ S T/Ctry _ _______ E xp _ ________

Date o f B irth _ ____________ H ome P hone _ _____________Work _ _______________ C ell _ _______________

Email _ ______________________ C ode W ord/Place o f B irth_________________________________________

Employer/Job T itle o r P osition _ _____________________________ R elation t o O wner _ ___________________

Remove J oint O wner(s) f rom t he f ollowing:

! A ll S hare A ccounts o r

! D esignate S pecific A ccounts: _ _________ _ _________ _ _________ _ _________

The above removed joint owner(s) relinquishes ownership interest including any membership share in the

account(s) a s d esignated a bove. T his r elinquishment d oes n ot a ffect m y/our o bligation o n a ny l oan a ccounts.

Signature o f J oint O wner(s) _ ____________________________________Date__________________________

Membership Change Card Form