Building Picture EPB Employees Credit Union
1500 McCallie Avenue, Chattanooga, TN 37404 USA
Phone: (423) 648-3413, Fax: (423) 698-2912, email: epbecu@epbecu.org
Address Change Request Form
One Form Per Member

As a convenience, we are providing this form on-line to expedite your desire to change the address of record. Since, we are required to have written authorization from you permanently on file, please take a moment to type in the necessary information below. Once completed, please sign the form and FAX, mail or bring it to us as soon as possible. Each member having his/her own membership account (unless a minor less than 18 years of age) must sign a form, even if several members have the same address.
(Please Type Name)
(Account Number)

I have the following account types:
Shares/Savings/CDs/Loans
Draft/Checking
Visa Debit Card
MasterCard Credit Card
Visa Credit Card

 For Credit Union Use
[______] CUSA
[______] Liberty Direct
[______] Fiserv EFT
[______] Certegy
[______] Certegy

Change my address of record starting (date):
(Please Type Date)
Old Mailing Address:

 New Mailing Address:

New Physical Address (if different from above or if a P.O. Box is used above):

Member’s Signature: _____________________________________ Date: ___________________
(Please Sign Name)

In accordance with the Internal Control Policy and the Information Security Program, the following form is used to document and/or authorize changes to members’ accounts. This form will be reviewed by Management, Supervisory/ Audit Committee, Independent Auditors and State Examiners to verify compliance and authenticity.

For Credit Union Use: Checked off Member Audit Report (M601) and filed in Membership File. _________________