Community Financial Credit Union
Account Closure Request Form

This information will assist us in verifying the identity of the account holder in order to help prevent any fraud attempts on this account. If you have questions please call us at 417-862-0471 or 888-430-7199.

1. Complete this form and print. This form may not be returned online because your signature is required.
2. Return this completed form to our office, by fax to (417) 862-7802, or by mail to Community Financial
....Credit Union (CFCU), Attn: Member Services, PO Box 1217, Springfield MO 65801-1217.
3. Please enclose a copy of a valid picture I.D. with this form.
Member Name
(as listed on account):
Address:
City:
State: ZIP Code:
Social Security #:
Date of Birth:
(mmddyyy)
Driver's License #: State of issue:
Telephone:
Mother's Maiden Name:
Password on Account
(if applicable):

Reason for Closing Account:
(Select one response which best describes your reason for closing your account.)
Moving out of area
Changed employer - no payroll deduction
Need the money
No longer use account
Unhappy with service
Inconvenient location
Better rates elsewhere
Didn't qualify for loan
Paid off loan
Death of member
Fees
Telemarketers
Lost/stolen checks
Other:

Card Destruction Verification
I verify that my (select applicable card(s) and enter card number(s)):
VISA Card Number
ATM Card Number
VISA Check Card Number

is enclosed or has been previously destroyed and is no longer in my possession. I will take the full responsibility for all future charges, if any, on this account.


Signature ________________________________________ Date ___________________

Signature ________________________________________ Date ___________________