Change of Address Form

Change of Address Form
Dear Customer: Regardless of where you are moving, we want to make your move easier. When you know your new address,
please complete this Change of Address Form, tell us when your move will be effective, and return this form to us. We will update
our records so that your statements and other correspondence are sent to your new location after the move. Our staff will be
happy to assist you in completing this form, ordering checks with your new address, or with any questions you may have.
ACCOUNT NAME
SSN OR TIN
EFFECTIVE DATE
OLD MAILING ADDRESS
CITY
STATE
NEW MAILING ADDRESS
NEW PHYSICAL ADDRESS – INCLUDE CITY AND ZIP (IF DIFFERENT)
CITY
STATE
HOME TELEPHONE
ZIP CODE
ZIP CODE
BUSINESS TELEPHONE
CELL / MOBILE NUMBER
E-MAIL ADDRESS
IF ANY OF THE BELOW FIELDS ARE COMPLETED, THE
FORM MUST BE SENT TO DEPOSIT OPERATIONS AFTER
MAINTENANCE IS PERFORMED.
IF ANY OF THE BELOW FIELDS ARE COMPLETED, THE
FORM MUST BE SENT TO LOAN OPERATIONS AFTER
MAINTENANCE IS PERFORMED.
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CHECKING, NOW, MONEY MARKET
CONSUMER/AUTO LOAN
ACCT#:
ACCT#
ACCT#:
ACCT#:
DEBIT CARD#:
ACCT#:
o
o
o
SAVINGS
REAL ESTATE/COMMERCIAL LOAN
ACCT#:
ACCT#:
ACCT#:
ACCT#:
o
CERTIFICATE OF DEPOSIT / IRA
ACCT#:
CREDIT CARD
CARD#:
ACCT#:
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SAFE DEPOSIT BOX
BOX#:
AUTHORIZED SIGNATURE
OTHER SERVICES
DESCRIBE:
DATE
AUTHORIZED SIGNATURE
DATE
FORWARD CHANGES OF ADDRESS TO:
CITIZENS BANK
P O Box 569
Robertsdale, AL 36567
BANK USE ONLY
SIGNATURE VERIFICATION
EMPLOYEE SIGNATURE
DATE CHANGED