Visa Card Account Access Change
/
Date
/
(dd/mm/yyyy)
Member Number Member Name
Address
City
State
Postcode
Email/s Home Phone/s
Mobile Phone/s
I/we the undersigned hereby request Orange Credit Union Ltd to change accounts accessed by my/our Visa Card(s). I/we understand that this access change could take up to 24 hours and I/we may not be able to use my/our Visa Card(s) for this period of time. I/we further understand and agree that, after any such change in access; I/we will continue to be bound by the `Visa Card Conditions of use' of Orange Credit Union Ltd. I/we understand that I/we can obtain the latest version of the conditions of use from Orange Credit Union Ltd at any time.
Account from which access is to be withdrawn
S
First account to which access is to be given
S
Second account to which access is to be given
S
(Access through rediATM only)
Visa Card 1 Number
Visa Card 2 Number
Signature 1
Signature 2
FRONT OFFICE USE ONLY Received by:
Op. No.
Date:
Security questions asked and updated:
BACK OFFICE USE ONLY Visa Card access changed: (P & R - P811 - Maintain Accounts) Op. No.
Date:
Member Signature Verified: Address details checked: (P & R) First A/c type to be accessed:
S
Second A/c type to be accessed: S
FRM 0139 3/0815
If the address has been amended, please complete section below: Security questions asked and updated
Yes
No
Address amended: (P & R - edit `Address Details')
Yes
No
Other services notified (MyCard, QBE):
Yes
No
Linked member address updated?
Yes
No
288 Summer Street, PO Box 992, Orange NSW 2800 Tel: 02 6362 4466 • Fax: 02 6363 1208 • Rediphone: 02 6361 1166 DX: 3041 • BSB: 802 129 • ABN 34 087 650 477 • AFSL 240768 Email:
[email protected] • www.orangecu.com.au
Page 1 of 1
