ADDRESS CHANGE FORM

Date____________________________________

Member Name___________________________________________________________

New Address____________________________________________________________

City_____________________________ State_________________ Zip______________

Home Phone____________Work Phone___________Email Address________________

The above address should be placed on the following accounts:
1. _____________________ 2. _____________________ 3. _____________________

4. _____________________ 5. _____________________ 6. _____________________

_____________________________________ __________________ _______________
Member's Signature                                            Completed on Aftech by       Verified by

Mail completed form to: Mid American Credit Union 8404 West Kellogg Drive Wichita, Kansas 67209