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Form 960 (Rev 09/19)
ACCOUNT NUMBER CHANGE
AUTHORIZATION FORM
Current Membership #: _____________________ Requesting Branch: _______________________
1. I understand that changing my member number (“account number”) is permanent. Once my account number has
been changed, I may not request to change it back to the former account number.
2. I understand that all current account owners and pay-on-death beneficiaries (as reflected on the most recent
account Signature Card on file) will remain in effect and will be transferred to the new account number.
3. I understand that I may be required to complete and sign a new signature card, along with all other account
owners.
4. The Credit Union will notify me that my new account number has been established and provide me with the
new account number. My preferred method of contact is:
Encrypted Email: Phone: Mail:
5. Billp@yer Account? Yes No
If I am an active Billp@yer user, I understand that I do not need to establish a new Billp@yer account because it
will automatically be transferred to the new account within two (2) business days.
6. I agree to reset my CU.online Username and Password immediately as an added security measure.
7. If I have a recurring automatic ACH Debit and/or Direct Deposit (ACH Credit), it is my responsibility to provide my
new account number to the originator.
8. If I have written checks that to-date have not been paid under my existing account number, I understand
that they may be returned “Unable to Locate” unless other arrangements are made. This includes pre-authorized
ACH debit items. For the next 30 calendar days, the outstanding items listed below should be paid from the new
account: (For more space, attach a separate page and mark this box )
Check # or ACH
Debit
Amount
Check # or ACH
Debit
Amount
Check # or ACH
Debit
Amount
9. Below is a list of my current Direct Deposit(s) to credit to th
e new account number for the next 30-calendar
days
Direct Deposit Amount Direct Deposit Amount Direct Deposit Amount
First500 Savings Account Owner:
I agree to the above terms and conditions and authorize the Credit Union to change my account number.
Primary Member: ________________________________ ___________________________________ _______________
Print Name Signature Date
Daytime Phone Number: ____________________________
Email: ______________________________________
