Texas Partners Debit Card Application

Address Change

Primary Account Holder Information

Member Number:

First Name:

Middle Initial:

Last Name:

Social Security Number:

Drivers License Number:
State:

Date of Birth

Phone Number:

( )

Alternate Phone Number:

( )

Email Address:

New Street Address:

New City:

New State:

New Zip:

Previous Street Address:
Previous City:

Previous State:
Previous Zip:

Do you have a:

Debit Card IRA

Additional Comments:

I am the primary account holder of the above account and request this address change. (Enter YES in the box)

Member Number:
First Name:	Middle Initial:
Last Name:
Social Security Number:
Drivers License Number:	State:
Date of Birth
Phone Number:	( )
Alternate Phone Number:	( )
Email Address:
New Street Address:	New City:
New State:	New Zip:
Previous Street Address:	Previous City:
Previous State:	Previous Zip:

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Your savings federally insured to at least $100,000 and backed by the full faith and credit of the National Credit Union Administration a U.S. Government agency. We do business in accordance with the Federal Fair Housing Law and the Equal Credit Opportunity Act.