EFTA00186559¶
| Melavante Corporation Credit Card Services CREDIT CARD ACCOUNT MAINTENANCE Account Record, Card, PIN | ||
| Act# Name Business Name Office LLC | ||
| Account Record Changes | ||
| Close Account | For Martial Property States Only | |
| Cards Returned | Married Not Married Legally Separate | |
| Re-Open Account | Spouse's Name | |
| Add Soc. Sec.: | Street Address | |
| Add Telephone # | City, State, ZIP | |
| Home Business From: To: | Card Issurance | |
| Address Change to City, State, ZIP | Order New Card for Must mark below to indicate the type of card ordered Send Card: | |
| Add Cardholder | Normal Delivery - 7 to 10 days Express Delivery - 2 days ($10.00 charge) Saturday Delivery ($10.00) | |
| Order Card | Saturday Delivery ($10.00) | |
| Delete Cardholder | Charge: Cardholder Financial Institution Address to Mail Card Name | |
| Add Authorized User | Street Address Financial Institution City, ST, ZIP New York, NY 10022 | |
| Order Card | Charge Cardholder Replacement Card Fee of$ | |
| Delete Authorized User | PIN Issurance | |
| Delete Credit Rating | Order PIN Reminder | |
| Add Type Code | PIN Express Delivery - 3 days ($10.00 charge) | |
| Add Automatic Payment Detection TR&R Checking Access# | Change: Cardholder Financial Institution Send PIN to Alternate Address Below Name | |
| Minimum payment Previous balance | Street Address | |
| Delete Automatic Payment Deduction | City, ZIP | |
| Add E-mail Address | Balance / Payment Transfers | |
| Add Mother's Maiden Name | Transfer balance of$ From account# To account# | |
| Add Secondary CH SS# | Transfer payment of$ From account# To account# | |
| Add Secondary CH DOB | Convenience Checks | |
| Add Secondary CH Daytime Phone | Convenience Checks - # of books | |
| Add Fax Number | Street Address | |
| Add Cell Phone# | City, State, ZIP | |
| Add Pager Number | ||
| Privacy Option | ||
| Insurance Add Insurance Delete Insurance I/hold insurance, attach a signed copy of the insurance application | ||
| Free Text Message/Miscellaneous instructions | ||
| Create possibly compromised block access and issue new card | ||
| Financial institution Name: Colonial Bank Authority Signature: Print Name: Telephone: Ext. | ||
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