| Melavante Corporation CREDIT CARD ACCOUNT MAINTENANCE Account Record, Card, PIN |
| Acct #NameMichael SammondsBusiness NameN5320C | For Marital Property States OnlyMarriedNot MarriedLegally SeparSpouse's NameStreet AddressCity, State, ZIP |
| Account Record Changes |
| Close AccountCards RenewedCards Not ReturnedRe-Open AccountRemove Reissue BlockAdd Soc.Sec.Add Telephone#HomeBusinessFrom:To:Address Change toCity, State, ZIPAdd CardholderOrder CardDo Not Order CardDelete CardholderAdd Authorized UserOrder CardDo Not Order CardDelete Authorized UserDelete Credit RatingDelete Credit CodeDelete Automatic Payment DeductionT/R#Checking Accr#Minimum paymentPrevious balanceDelete Automatic Payment DeductionAdd E-mail AddressAdd Mother's MaidenNameAdd Secondary CH SS#Add Secondary CH DOBAdd Secondary CH Daytime PhoneAdd Fax NumberAdd Cell Phone#Add Pager NumberPrivacy Option | Card IssuanceOrder New Card forMust mark below to indicate the type of card orderedSand Card:Normal Delivery-7 to 10 daysExpress Delivery-2 days ($10.00 charge)Express Delivery ($10.00 charge)Fascard-1 day ($20.00 charge)Saturday Delivery ($10.00)Charge:CardholderFinancial InstitutionAddress to Mail Card.NameStreet AddressCity, ST, ZIPCharge Cardholder Replacement Card Fee of $PIN IssuanceOrder PIN ReminderPIN Federal Express-3 days ($10.00 charge)CardholderFinancial InstitutionSend PIN to Alternate Address BelowNameStreet AddressCity, State, ZIP |
| InsuranceAdd insuranceDelete Insurance*Valid insurance attach a signed copy of the insurance applicationFree Text Messages/Nincellaneous instructions | Balance/Payment TransfersTransfer balance of$From account#To account#Transfer payment of$From account#To account#Convenience ChecksSend Convenience Checks-# of booksNameStreet AddressCity, State, ZIP |
| Financial Institution Name:Colonial BankDate:356163Authorized Signature:Bank#1550Agent#1554PrintName:Jeffrey DesmondTelephone: |
EFTA00186548
# AP Tracking Number:
| Metavante Corporation CREDIT CARD ACCOUNT MAINTENANCE Account Record, Card, PIN |
| Acc# Name Business Name | For Marital Property States Only |
| Account Record Changes | |
| Close Account | Married Not Married Legally Separated Spouse's Name Street Address City, ZIP |
| Card Returned | Card Not Returned |
| Re-Open Account | Remove Reissue Block |
| Add Sec. Sec # | |
| Add Telephone # | Home Business |
| Name Change From: To: | Normal Delivery - 7 to 10 days Express Delivery - 2 days ($10.00 charge) Saturday Delivery ($10.00) Fastcard - 1 day ($10.00 charge) Saturday Delivery ($10.00) |
| Address Change to City, State, ZIP | Charge: Cardholder Financial Institution Address to Mail Card: Name Street Address City, ST, ZIP |
| Add Cardholder Order Card Do Not Order Card | Order Card Cardholder Financial Institution Address to Mail Card: Name Street Address City, ST, ZIP |
| Delete Catchcard Add Authorized User Order Card Do Not Order Card | Delete Catchcard Cardholder Financial Institution Address to Mail Card: Name Street Address City, State, ZIP |
| Delete Authorized User Delete Credit Rating Delete Credit Rate | Delete Credit Rating Delete Credit Rate |
| Add Type Code Delete Automatic Payment Detection TRR Checking Acc# | Delete Automatic Payment Detection TRR Checking Acc# |
| Minimum payment Previous balance | Delete Automatic Payment Detection TRR Checking Acc# |
| Delete Automatic Payment Detection Add Email Address Add Mother's Maiden Name | Transfer Balance of$ From account# To account# Transfer payment of$ From account# To account# |
| Add Secondary CH SS# | Transfer payment of$ From account# To account# |
| Add Secondary CH DOB | Transfer payment of$ From account# To account# |
| Add Secondary CH Daytime Phone | Transfer payment of$ From account# To account# |
| Add Fax Number | Transfer payment of$ From account# To account# |
| Add Cell Phone# | Transfer payment of$ From account# To account# |
| Add Fager Number | Transfer payment of$ From account# To account# |
| Privacy Option | Transfer payment of$ From account# To account# |
| Insurance | Convenience Checks Send Convenience Checks - # of books Name Street Address City, State, ZIP |
| Add Insurance Delete Insurance | Send Convenience Checks - # of books Name Street Address City, State, ZIP |
| Free Text Messages/Miscellaneous Instructions |
| |
| Financial Institution Name: Colonial Bank Date: Print Name: Jeffrey Daumond Agent: Ext. |
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