If you have had a change in address, phone number or e-mail address, please print, complete and sign this form.
Please bring this to one of our locations so we may update your information. You may also mail to 1120 W 17th Street, Tulsa OK 74107 or fax 918-582-7588
Member Name | Member # |
---|---|
Physical Address | Mailing Address (if different) |
Street: | Street: |
City, State & zip: | City, State & zip: |
Contact Information | |
Home: | Cell: |
Work: | Alt: |
List of Joint Owners That Changes may Apply to | |
Name: | Phone: |
Name: | Phone: |
Name: | Phone: |
Name: | Phone: |
Please check if you have an active ATM or Debit card. |
Signature:__________________________________________ Date: _______/_________/__________
Signature:____________________________ Date: _____/_____/______ Branch: ________________________
EFT DATE 3/28/16