Member Name/Address/Phone Number Change Form
Please process the following updates (check all that apply):
Name Change (Visa Card)
Primary Mailing Address
Secondary Mailing Address
Phone Number
Email Address
CU Account No. (list all account numbers that need to be updated)
Member Name (First & Last Name)
(If you are requesting a name change, please enter your name as it currently
appears on your account.)
Online Bill Pay user?
Classic Visa Card No. (full 16-digits)
Primary
Joint
User
Platinum Visa Card No. (full 16-digits)
Primary
Joint
User
Yes
No
If yes, SCU staff must update the address
within Partner Care website.
Outdoor Adventure Card No. (full 16-digits)
Primary
Joint
User
Business Visa Card No. (full 16-digits)
Primary
Joint
User
NEW Name:
Please order a Visa card with new name.
New Name (First & Last Name)
OLD Address/Phone/Email:
Address
City
Country
Phone Number
State
Zip Code
Cell Phone Number
Email Address
NEW Address/Phone/Email**:
Address
City
Country
Phone Number
State
Zip Code
Cell Phone Number
Email Address
**A copy of your valid Driver's License or State ID must be included for verification. Your address cannot be changed without this being included.
Member Signature
Date
Comments:
Completed by
Ext.
Teller No.
Date
OPEIU 393 AFL-CIO (Revised 11/2/15)
w:\forms\Address Change Form.pdf
Credit Union Use Only:
Print Form
Submit Form
Date Processed:
Teller No.:
Date Processed:
Visa Dept.:
Date Processed:
OBP:
*Forward signed copy to Communications Center once processed.