Account Change Request Form

Account Change Request

CURRENT ACCOUNT INFORMATION
Primary member's full name:*
First Middle Last
Please list the account numbers that need changing:*
CHANGE TYPE(S)
Check all that apply:*
- Add / Close Account
- Add / Remove Owner
- Address / Phone / Email Change
- Name Change
- Beneficiary Change (excludes trust accounts)
- Add / Remove Service(s)
- Mail Handling Change
- Other:
Other

Other change type...
Do you require more space for additional information?
- Yes
- No
Additional information:
ADD OR REMOVE ACCOUNTS / SERVICES
Check the services you'd like to add or remove:*
- Payroll Deduction
- Add
- Remove
Share / Savings
- Share / Savings
- Add
- Remove
Share Draft / Checking
- Share Draft / Checking
- Add
- Remove
ATM / Check Card
- ATM / Check Card
- Add
- Remove
Student Checking
- Student Checking
- Add
- Remove
Over-Draft Protection
- Over-Draft Protection
- Add
- Remove
Bounce Safe / Courtesy Pay
- Bounce Safe / Courtesy Pay
- Add
- Remove
Home Banking
- Home Banking
- Add
- Remove
Fresh Start Checking
- Fresh Start Checking
- Add
- Remove
Club Account
- Club Account
- Add
- Remove
Touchtone Teller
- Touchtone Teller
- Add
- Remove
Share Certificate
- Share Certificate
- Add
- Remove
Line of Credit
- Line of Credit
- Add
- Remove
Direct Deposit
- Direct Deposit
- Add
- Remove
Money Market
- Money Market
- Add
- Remove
Bill Pay
- Bill Pay
- Add
- Remove
Other
- Other
Other account or service...

Other account or service...
Do you require more space for additional information?
- Yes
- No
Additional information:
NAME CHANGE
New name:
First Middle Last
Driver's license number:
ADDRESS / CONTACT INFO / EMPLOYER CHANGE
Which of the following are you looking to change?
- Address(es)
- Phone number(s)
- Email
- Employer information
New physical address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Is the new mailing address the same as the above?
- Yes
- No
New mailing address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home phone:
Cell phone:
New email address:
Enter Email Confirm Email
Have you retired from this occupation?
- Yes
- No
Occupation:
New employer name:
New employer address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
New employer phone number:
Business phone Ext.
New security / verification code, or mother's maiden name:
CHANGE MAIL HANDLING
- Hold all mail
- Remove mail hold
Effective date:
MM slash DD slash YYYY
ACCOUNT OWNERSHIP CHANGES
Please select which of the following actions you wish to take:
- Name/change account owner
- Name/change agent
- Add owner
- *Remove owner
*By choosing the “Remove Owner” option above, you have chosen to remove the selected owner(s) from the account(s) designated on this form. You understand that removal of a Multiple Party Account Owner requires consent of all account owners, and you will hold the credit union harmless for actions regarding account access. The removed account owner(s) relinquishes ownership interest including any membership share in the account(s) set forth above. This relinquishment does not affect your obligation of any loan account(s).
- I/we agree.
*By choosing the “Remove Owner” option above, you have chosen to remove the selected owner(s) from the account(s) designated on this form. You understand that removal of a Multiple Party Account Owner requires consent of all account owners, and you will hold the credit union harmless for actions regarding account access. The removed account owner(s) relinquishes ownership interest including any membership share in the account(s) set forth above. This relinquishment does not affect your obligation of any loan account(s).
SHARE / SAVINGS ACCOUNTS
Check all that apply:
- Share (savings)
- Club
- Certificate (CDs)
- Student
CHECKING ACCOUNTS
Check all that apply:
- Free checking
- Fresh Start
- Student
- Money market
OWNER INFORMATION
Name:
First Last
Date of birth:
Social Security Number:
Physical address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Mailing address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home phone:
Cell phone:
Email:
Enter Email Confirm Email
Employer:
New employer phone number:
Business phone Ext.
Occupation:
Driver's license state of issue:
Driver's license number:
- Grant Rights of Survivorship?
Would you like to make another ownership change?
- Yes
- No
Name:
First Last
Date of birth:
Social Security Number:
Physical address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Mailing address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home phone:
Cell phone:
Email:
Enter Email Confirm Email
Employer:
New employer phone number:
Business phone Ext.
Occupation:
Driver's license state of issue:
Driver's license number:
- Grant Rights of Survivorship?
PAYABLE ON DEATH BENEFICIARIES

By signing below, each party designates the person(s) named below as Payable on Death Beneficiaries on the accounts indicated. You agree to save, defend and hold The Focus Federal Credit Union harmless from any liability in connection with this POD designation. Designation not available on Multiple Party Accounts without Right of Survivorship.
- I agree.
PRIMARY
Will you be adding or removing a Beneficiary?
- Add
- Remove
ACCOUNT TYPE(S):

SHARE / SAVINGS ACCOUNTS
- Share (savings)
- Club
- Certificate (CDs)
- Student
CHECKING ACCOUNTS
- Free checking
- Fresh Start
- Student
- Money market
Name:
First Middle Last
Social Security Number:
Relationship:
Physical address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Date of birth:
Phone number:
Add or remove another Beneficiary?
- Yes
- No
Will you be adding or removing this Beneficiary?
- Add
- Remove
ACCOUNT TYPE(S):

SHARE / SAVINGS ACCOUNTS
- Share (savings)
- Club
- Certificate (CDs)
- Student
CHECKING ACCOUNTS
- Free checking
- Fresh Start
- Student
- Money market
Name:
First Middle Last
Social Security Number:
Relationship:
Physical address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Date of birth:
Phone number:
Would you like to name or edit a Contingent Beneficiary?
- Yes
- No
CONTINGENT
Will you be adding or removing a Beneficiary?
- Add
- Remove
ACCOUNT TYPE(S):

SHARE / SAVINGS ACCOUNTS
- Share (savings)
- Club
- Certificate (CDs)
- Student
CHECKING ACCOUNTS
- Free checking
- Fresh Start
- Student
- Money market
Name:
First Middle Last
Social Security Number:
Relationship:
Physical address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Date of birth:
Phone number:
Add or remove another Contingent?
- Yes
- No
Will you be adding or removing this Beneficiary?
- Add
- Remove
ACCOUNT TYPE(S):

SHARE / SAVINGS ACCOUNTS
- Share (savings)
- Club
- Certificate (CDs)
- Student
CHECKING ACCOUNTS
- Free checking
- Fresh Start
- Student
- Money market
Name:
First Middle Last
Social Security Number:
Relationship:
Physical address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Date of birth:
Phone number:
AUTHORIZATION
By signing below, I/we agree that the changes on this form amend the previously signed Membership Document and are subject to the terms and conditions of the Membership Disclosure, Schedule of Fees and Charges, and to any amendment the credit union makes from time to time which are incorporated herein.
*
- Check this box to sign the form.
Signature*
Date:*
MM slash DD slash YYYY
Type:*
- Primary
- Joint Owner
- Agent
Is another signature required?
- Yes
- No
Signature
Date:
MM slash DD slash YYYY
Type:
- Primary
- Joint Owner
- Agent
Is another signature required? (2)
- Yes
- No
Signature
Date:
MM slash DD slash YYYY
Type:
- Primary
- Joint Owner
- Agent
Is another signature required? (3)
- Yes
- No
Signature
Date:
MM slash DD slash YYYY
Type:
- Primary
- Joint Owner
- Agent
- I/We, the above members of The Focus Federal Credit Union have elected to opt out of my personal information being shared with FFCU business partners.
Comments
This field is for validation purposes and should be left unchanged.

Account Change Request

CURRENT ACCOUNT INFORMATION

CHANGE TYPE(S)

ADD OR REMOVE ACCOUNTS / SERVICES

NAME CHANGE

ADDRESS / CONTACT INFO / EMPLOYER CHANGE

CHANGE MAIL HANDLING

ACCOUNT OWNERSHIP CHANGES

SHARE / SAVINGS ACCOUNTS

CHECKING ACCOUNTS

OWNER INFORMATION

PAYABLE ON DEATH BENEFICIARIES

PRIMARY

ACCOUNT TYPE(S):

SHARE / SAVINGS ACCOUNTS

CHECKING ACCOUNTS

ACCOUNT TYPE(S):

SHARE / SAVINGS ACCOUNTS

CHECKING ACCOUNTS

CONTINGENT

ACCOUNT TYPE(S):

SHARE / SAVINGS ACCOUNTS

CHECKING ACCOUNTS

ACCOUNT TYPE(S):

SHARE / SAVINGS ACCOUNTS

CHECKING ACCOUNTS

AUTHORIZATION