Fillable Change of Account Name Form (City of West Memphis)

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Change of Account Name Form (City of West Memphis)

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WMUC, CAN Form, Revised 8/12
Change of Account Name Form
In accordance with WMUC Policy 7.15 Name Change Policy: We will be unable to
change the name on an account; except, due to marriage or in the event of a spouse's
death. In all other request the account will have to be final billed and new deposit made
in the new name.
Name: _____________________________________________________________________
Address: ___________________________________________________________________
Account Number: ____________________ Phone: ________________________________
CURRENT ACCOUNT INFORMATION (PLEASE PRINT)
NEW NAME ON ACCOUNT (PLEASE PRINT)
Name _____________________________________________________________________
Reason for Name Change: Marriage__________________ Spouse’s Death___________
(Attach Documentation: Govt. ID, Marriage License, Death Certificate, etc.)
FOR OFFICE USE ONLY
Received By: __________________ Date: _____________
Completed By: _______________ _ Date: ____________
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Change of Account Name Form (City of West Memphis)

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Completed 17 July 2020

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