Account Change Form printable pdf download

(800) 226-6673

Office Use Only

MSR Name: ______________________

Document Type: Account Change Form

Date processed ____________________

PUBLIX EMPLOYEES FEDERAL CREDIT UNION

ACCOUNT CHANGE FORM

This form may be used to change your name or to remove a joint owner from any of your existing accounts. Complete only the

applicable portions of this form.

If not appearing in person, mail to the nearest PEFCU branch office with a photo copy of your identification. Identification

accepted: Valid Driver’s License or State ID. This form will not be processed without proper identification.

NAME: ______________________________ ACCOUNT # __________________________

DATE: __________________________

□

CHANGE NAME

- In addition to your photo ID, proof of the name change must be submitted by providing a copy of your new social

security card, court order OR marriage license.

Please change my name from ___________________________________________ to ______________________________________.

□ I currently have a Visa Checkmate Debit, PEFCU ATM, and/or Visa Credit Card. By initialing below I agree to the Governing law and

terms and conditions on my original Debit, ATM and/or Credit Card application(s). I request the card(s) to be reissued in my new name.

Initials required next to the card(s) being replaced.

_________ Visa Checkmate card

_________ PEFCU ATM card

__________ Visa Credit Card

□ Additional account number(s) ____________________________________

□ I would like to order a box of checks in my new name. (Check fees apply.)

□ I have a Safe Deposit Box and need the additional documentation to change my name on the box.

□ I have an IRA and need the additional documentation to change my name on the IRA account.

□

REMOVE JOINT OWNER (

Funds will be withdrawn from the above mentioned account number. It will be closed and reopened in my

name only. I take full responsibility of the account from this point forward. All additional owners on the account must also sign this form.)

Please remove __________________________________________________________________________ from my account.

□ Savings/Club accounts

□Checking

□ Money Market

Remove joint owner from:

□ I would like to order a box of checks in my name only. (Check order fees apply.)

REQUIRED SIGNATURE(S)

By Signing this form I agree to the terms and conditions found in the “Important Account Information” Brochure and the Governing Law on

my original Membership, Checkmate Debit, ATM, and/or Visa Credit Card application(s).

Owner signature: _________________________________________ Owner signature: ________________________________________

Rev. 9/15

Account Change Form