ADDRESS CHANGE AUTHORIZATION FORM

ADDRESS CHANGE
AUTHORIZATION FORM
DATE:
Please Note: In order for Bank of New Hampshire to maintain your records as accurately as possible, you must list all members of your
household affected by this change.
I (We) hereby authorize Bank of New Hampshire to change my (our) address to read as follows:
Name Rec. #
NAMES:
SOC. SEC. #
Name Rec. #
Name Rec. #
NEW MAILING ADDRESS:
CITY, ST, ZIP
NAME TO ADDRESS RELATIONSHIP
PHYSICAL ADDRESS: (If a PO BOX is used for mailing)
HOME PHONE #
BUSINESS PHONE #
CELL PHONE #
Business Phone Owner:
EMAIL ADDRESS
EMAIL ADDRESS
Cell Phone Owner:
Owner:
Owner:
I am currently a member of:
Prestige Plus
YES
NO
YES
BNH Financial Services
NO
Trust Services.
YES
NO
Please provide ALL account & debit card numbers you would like to have changed to reflect the new mailing address.
(#'s must be listed)
SIGNATURE:
SIGNATURE:
FOR BANK USE ONLY
REMOVE BAD ADDRESS CODE "B"?
YES
NO
Bad Address code is attached to account.
CURRENT PORT # (S):
COMBINE PORTS?
YES
NO
NEW PORT REQUIRED?
RECEIVED BY:
YES
NO
OFFICE:
DATE:
Additional Information:
BANK OFFICE SUPPORT/OFFICE:
DATE:
PRESTIGE PLUS REP. :
BNH FINANCIAL SERVICES
DATE:
TRUST SERVICES:
Bank of New Hampshire 62 Pleasant Street Laconia NH 03246
Member FDIC
DATE:
DATE:
Equal Housing Lender
FEB 2013