ACCOUNT CHANGE OF ADDRESS FORM
Details are important when you are moving. Don’t forget about us! When you know your new address, please complete this
change of address form, indicating when it will become effective. We will update our records so your statements and other
correspondence are sent to your new location. Please let a banker know if you need to order checks with your new address.
Customer Name(s):
Old Mailing Address:
____________________________________
___________________________________
____________________________________
___________________________________
New Mailing Address:
Physical Address (if different from mailing address):
____________________________________
___________________________________
____________________________________
___________________________________
Please list any phone numbers where we can reach you, who the number belongs to and what type of
number it is (cell, home, work, etc.)
Phone Number: ______________________ belongs to ___________________ Type _________________
Phone Number: ______________________ belongs to ___________________ Type _________________
Phone Number: ______________________ belongs to ___________________ Type _________________
Phone Number: ______________________ belongs to ___________________ Type _________________
_______________________________________________________________________________________
Effective Date: ___________________
Is this a seasonal address? _____ if so, please indicate the start and stop dates at your alternate address.
No
Start: _____________________ Stop: _____________________
Please indicate the accounts to be changed:
Checking: _______________ _______________
CDs:
______________ _______________
_______________ _______________
______________ _______________
Savings:
_______________ _______________
Money Market: ______________ ______________
_______________ _______________
Safe Deposit Box # ______________
Loans:
_______________ _______________
Debit Card #: _______________________
_______________ _______________
Debit Card #: _______________________
Other:
_______________ _______________
Other: _________________ __________________
Authorized Signature: ____________________________________ Date: ______________________
Printed Name: ________________________________________ Completed By: _____________
Please return this completed, signed and dated form in person or by mail to:
Ridgestone Bank
Attn: Deposit Operations
13925 West North Avenue
Brookfield, WI 53005
13925 West North Avenue
10 N. Martingale Road, Suite 100
Brookfield, WI 53005
Schaumburg, IL 60173
Submit
Print
(262) 789-1011
(847) 805-9520