Fill - Free fillable ACCOUNT CHANGE REQUEST FORM Please Print or Type PDF form

ACCOUNT CHANGE REQUEST FORM

Please Print or Type

CURRENT ACCOUNT HOLDER NEW ACCOUNT HOLDER

Name:_____________________________ Name: _____________________________

Address:___________________________ Address:____________________________

City, State, Zip:______________________ City, State, Zip:_______________________

Best Contact #:______________________ Best Contact #:_______________________

Account Number:_____________________ Account Number:_____________________

Email Address:_______________________ Email Address:_______________________

Select the reason for the request:

 Account holder is deceased

Select the change you would like to make:

 Disconnect this account on ____/_____/_____

(Please specify date to disconnect)

Please select ONE of the below - Refund Check Payable to:

☐

Account Holder’s Name

☐

“The Estate of” the Account Holder

 Transfer this account to a new account holder

(includes equipment and/or access to email and voice mail)

Submit this form and determine the additional documentation you will need to submit with the request below:

Reason For Request Documentation Needed

Account Holder is Deceased

(Disconnect or Transfer to New Account Holder)

 Copy of the death certificate; OR

 Valid Government issued picture identification for the person submitting Xfinity Affidavit AND

Xfinity Affidavit for Deceased Customer (not required if death certificate is supplied)

XFINITY

AFFIDAVIT FOR DECEASED CUSTOMER

(not required if death certificate is supplied)

I _______________________________, being duly sworn according to law, declare that I am the [spouse] [next of kin] [executor or

administrator of the estate] (Circle one) of___________________________________ (“Decedent”) who died on or about the

day of , 20__.

Fill In One Option Below

[I request that Comcast disconnect Comcast account #_____________________for service at _______________________ (Address)

________________ (City), ________________ (State) _____________ (Zip Code). The final bill should be sent to

_______________________ (Address) ________________ (City), ________________ (State) _____________ (Zip Code).]

[I request that Comcast transfer Comcast account #__________________ for service at

_______________________________(Address) ________________(City), ________________ (State)_____________(Zip Code) to

my name.

I understand in requesting such transfer:

If applicable, I certify that I am authorized to view or hear any messages left in the Decedent’s Xfinity Digital Voice voicemail box,

receive call detail records or view emails left in the Decedent’s Xfinity Internet email account.

I am accepting assignment of any Xfinity agreements entered into by the current account holder, including, but not limited to, Xfinity

Mobile agreements, Xfinity Home agreements or minimum term agreements. I have reviewed these agreements and understand these

agreements include early termination fees if terminated prior to the expiration of the term agreement. I understand that I will be liable for

any Comcast owned equipment on the account and if there is Comcast owned equipment that I no longer wish to use with the Xfinity

services it is my obligation to return the equipment to Comcast or I will be charged for the equipment..

I agree to be bound by the Comcast Agreement for Residential Services

(https://www.xfinity.com/Corporate/Customers/Policies

/SubscriberAgreement).

I have reviewed and accept the Xfinity account elections made by the current account holder including, but not limited to, paperless

billing, notifications and marketing preferences and I understand how to change the elections.

I understand and agree that it is my responsibility to change the Xfinity account passwords and/or remove users from the account.

I have reviewed the Comcast Customer Privacy Notice (https://www.xfinity.com/Corporate/Customers/Policies

/CustomerPrivacy)

For account with Xfinity Voice: I understand and acknowledge that in order for 911 calls to be properly directed to emergency services,

Comcast must have my correct service address. If I move my Xfinity Voice equipment to a different address without Comcast’s

approval, 911 calls may be directed to the incorrect emergency authority with the incorrect address, and my phone service, including

911, may fail. If there is an electrical power outage in my home, calling, including calls to 911, may be unavailable. Calls to 911 may not

be completed if there is a technical or other problem with Comcast’s network or other network facilities or databases used to complete

911 calls.

I agree to RELEASE, INDEMNIFY, AND HOLD HARMLESS Comcast, its subsidiaries, affiliates, their respective parents, officers,

employees, agents, successors and assigns from and against any claims, demands, actions, liens, rights, subrogated or contribution

interests, debts, liabilities, judgments, costs, and attorney’s fees, arising out of the this change of account status.

Dated at , this day of , 20 .

{City} {State}

Signature

Print Name

_______________________

Address Telephone

_______________________

Current Account Holder Name Account Number

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

ACCOUNT CHANGE REQUEST FORM Please Print or Type

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank ACCOUNT CHANGE REQUEST FORM Please Print or Type Form

Related forms

Fillable ACCOUNT CHANGE REQUEST FORM Please Print or Type

Fill Online, Printable, Fillable, Blank ACCOUNT CHANGE REQUEST FORM Please Print or Type Form

Related forms

First 20 documents completely FREE!