HELP ME SWITCH™ BUSINESS CUSTOMER AUTHORIZATION

HELP ME SWITCH™
BUSINESS CUSTOMER AUTHORIZATION FORM
FOR INTERNAL USE: Please fax to 1.877.523.4333
Date:
CUSTOMER INFORMATION:
Business Contact Name:
Tel (work):
Ext:
Business Name:
Tel (home):
Address:
Fax:
Email:
City:
Province:
Authorized Signing Officer(s)
(Please print)
Postal Code:
1.
3.
2.
4.
ACCOUNT INFORMATION:
Branch Name/Address: Select Branch Location
Branch Contact:
Phone:
CCS - Administration
604.517.7000
Fax:
ID No.:
Email: [email protected]
604.517.7810
8
New Account Number:
Transit No.
0
9
Inst. No.
Account No. (as it appears in MICR Line)
PHONE APPOINTMENT PREFERENCES (allow two business days lead time when scheduling):
1. What date/day (Monday to Friday) is best for a Customer Services
Representative to call?
/
DD
/
MM
or Choose...
YYYY
DAY
2. The best time-period (note: all times local):
8am – 10am
10am – 12pm
12pm – 2pm
3. Where?
at work
4. Language
preferred:
English
French
Cantonese
Mandarin
2pm – 4pm
4pm – 6pm
6pm – 8:00pm
at home
Other language requested:
Davis and Henderson will make their best efforts to accommodate this request.
BALANCE OF ACCOUNT TRANSFER REQUEST:
,
I (we) give Coast Capital Savings authorization to close my account at
and forward the balance to my Coast Capital Savings account on my behalf, once all of my pre-authorized transactions have
been transferred to my account.
Other Financial Institution
Account Number:
Other Financial Institution
Account Number:
Transit No.
Inst. No.
Account No. (as it appears in MICR Line on cheque)
Transit No.
Inst. No.
Account No. (as it appears in MICR Line on cheque)
CUSTOMER AUTHORIZATION:
By signing below, I acknowledge that Coast Capital Savings or its third party agent may use this information to complete the Help Me Switch
process. Furthermore, I acknowledge that a Coast Capital Savings representative or its agent will contact me to gather my preauthorized
transaction information in order to notify billers of a change to my bank account information. I authorize such billers and Coast Capital Savings
to transfer my preauthorized transactions to the above designated Coast Capital Savings account on my behalf.
I understand that Coast Capital Savings is not responsible for verifying these transactions. I consent to Coast Capital Savings Credit Union
collecting, using and disclosing the personal information in this document pursuant to the terms of the Coast Capital Savings Privacy Policy (a
copy of which is available at any branch or online at www.coastcapitalsavings.com).
Customer Signature(s) - Please Note: For joint accounts, both account holders are required to sign.
Authorized Signing Officer(s) x
/ x
x
/ x
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