CHANGE OF ADDRESS FORM
Member's Name: ________________________
Member's Account #: _____________________
MEMBER'S FORMER ADDRESS MEMBER'S NEW ADDRESS
Last Name: _______________________________ Last Name: _______________________________
Middle Initial: ______ Middle Initial: ______
First Name: _______________________________ First Name: _____________________________
Extra Address: ____________________________ Extra Address: ___________________________
Street Address: ____________________________ Street Address: __________________________
City: _____________________________________ City: ___________________________________
State: _______ State: _______
Zip: _____________________ Zip: _____________________
Email Address: ___________________________ Email Address: ________________________
Telephone Number: _______________________ Telephone Number: _____________________
If this change of address affects other members in your household having PFCU accounts, please list their account numbers below.
Account #: ______________________________ Account #: _____________________________
Account #: ______________________________ Account #: _____________________________
Phone Notification: _______________ Employee Name: ________________________
Signature(s) below authorize only your address to be changed on PFCU shares and loans of which you are either primary or joint. If an account has multiple members needing this address change, all must sign below.
Member Signature: _______________________________________
Member Signature: _______________________________________
Member Signature: _______________________________________
____________________________________________________________________________________
FOR OFFICE USE ONLY:
Computer Change
PFCU Employee _______