Business Account Contact Information Change Form - Lge Community Credit Union

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Business Account Contact
LGE USE ONLY
Teller #__________________________
Information Change.
Initials _____________ Date_________
At LGE Community Credit Union, the security of your account information is of the utmost importance to us. To minimize fraud risk,
protect your account(s), and avoid a bad address fee, please take a moment to complete this form and return it to the credit union.
Once we have received the completed form, we will be happy to update your records in our system.
Simply complete all areas of this form and sign where indicated. Current joint authorized signers should provide physical street address
information in compliance with the Patriot Act.
This form cannot be used to add authorized signers.
PLEAsE Print
PLEAsE Print
bUsinEss—
AUthorizED siGnEr:
Please complete the following:
PEr thE PAtriot ACt, a street address is required for
all authorized signers:
Business Name: ____________________________________________________
Name: _________________________________________________________
nEw ContACt inforMAtion—
Address: ________________________________________________________
Work Phone: ______________________________________________________
City: ____________________________ State:_______ __ Zip: ____________
Cell Phone: _______________________________________________________
Home Phone: ____________________________________________________
Email: ____________________________________________________________
Work Phone: ____________________________________________________
Cell Phone: _____________________________________________________
Mailing address (used for all LGE correspondence):
ADDitionAL AUthorizED siGnEr:
Address: __________________________________________________________
PEr thE PAtriot ACt, a street address is required for
all authorized signers:
City: ______________________________________________________________
Name: _________________________________________________________
State:___________________ ________________ Zip: ____________________
Address: ________________________________________________________
PEr thE PAtriot ACt, if you list a P .o. box for your mailing
City: ____________________________ State:_______ __ Zip: ____________
address, you must also provide a street address:
Home Phone: ____________________________________________________
Address: __________________________________________________________
Work Phone: ____________________________________________________
City: ______________________________________________________________
Cell Phone: _____________________________________________________
State:____________ _______________________ Zip: ____________________
ADDitionAL AUthorizED siGnEr:
PEr thE PAtriot ACt, a street address is required for
oLD ADDrEss—
all authorized signers:
Address: __________________________________________________________
Name: _________________________________________________________
City: ______________________________________________________________
Address: ________________________________________________________
State:____________________ _______________ Zip: ____________________
City: ____________________________ State:_______ __ Zip: ____________
Home Phone: ____________________________________________________
Work Phone: ____________________________________________________
Cell Phone: _____________________________________________________
List All LGE Account #s Affected:
__________________________________________
____________________________________
_______________________________________
__________________________________________
____________________________________
_______________________________________
All information must be completed. Please sign below and return to:
LGE Community Credit Union, 430 Commerce Park Drive, Marietta, GA 30060
Your savings federally insured to at least $250,000
and backed by the full faith and credit of the United States Government
NCUA
Signature: __________________________________________ Date_________________________
National Credit Union Administration, a U.S. Government Agency
07/11
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