Account Change - PDF document

Account Change Request PO Box 3247 E
Account Change Request PO Box 3247 El Centro, CA 92244 Phone: (760) 352-1540 | Fax: (760) 337-5422 www.ficu.com My Name: My Account # My new Address is: My old Address is: My mailing address is different than my physical address My new mailing address is: My old mailing address is: My new Home or Mobile Phone is: My new Work Phone is: Joint Owner Name Joint Number: Joint Owner Address Joint Owner SSN: Joint Owner Mobile #: Joint Owner Phone #: Joint Owner Email: Joint Owner DOB: Mother’s Maiden Name: ID # / Type / Exp. Date Employer / Occupation: Add this Beneficiary: Remove this Beneficiary: Address of New Beneficiary: Beneficiary Social Security #: Beneficiary DOB: Please close my First Imperial CU account. The reason I need to close this account is (check all that apply): Moving out of the area Poor service experience Not enough service options Paid off Loan No longer need I have another FICU account My loan was denied Other: All about me! I need to Change My Address and/or My Contact Information I need to Add a Joint Owner to My Account (with rights of survivorship) I need to Add or Remove a Beneficiary I need to Close My First Imperial CU Account Final Authorization My Signature: X _________________________________________________ Date: __________________ Joint Owner Signature: X _________________________________________ Date: __________________ I/We agree that changes on this form amend the previously signed Membership form, and I/We are subject to all terms and conditions of membership in First Imperial Credit Union.