WHEELER COUNTY STATE BANK / ATLANTIC SOUTH BANK
CHANGE OF ADDRESS REQUEST FORM
*Confirmation of your new address will be forwarded to both the previous and new addresses, for security purposes.
PREVIOUS ADDRESS INFORMATION
Name: SSN:
Address: Date of Birth:
City: State: Zip Code:
Previous Home Phone Number: Work Phone Number:
Employer: Email address:
NEW ADDRESS INFORMATION
Date change to be effective:
New Home Phone Number:
Address:
City: State: Zip Code:
ACCOUNTS AFFECTED Please list account(s) and/or card number(s)
Checking Savings Loans
C/D IRA Other
Credit Card Debit Card
AUTHORIZATION
Your signature is REQUIRED to process this form. For security purposes, this change of address does NOT take effect until seven calendar days from the receipt of this form if this form is NOT received in person.
SIGNATURE: _____________________________________ DATE: _____________________
Mail or Fax form to: Wheeler County State Bank Atlantic South Bank
P. O. Box 408 P. O. Box 1267
Alamo, GA 30411 Dublin, GA 31040
FAX: 912-568-7134 FAX: 478-272-7919
BANK USE ONLY: Verified Identity of Requester by: ID Type/Number: Signature Card: Other:
Received by: _______________ Confirmation Mailed on:
Change made on: By: ____________________________________________
Please forward to Debit Card/Credit Card if applicable
Wheeler County State Bank / Atlantic South Bank has received a change of address request for accounts listed at this address. If you DID NOT request the change of address, please notify the bank immediately at 478-272-6262 in Dublin and 912-568-7191 in Alamo. The address change will take effect in 7 days unless we hear otherwise.
The new address is:
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Wheeler County State Bank / Atlantic South Bank has received a request to change the address of record on your accounts at our institution to the address shown below.
If you did not request this change of address, please notify the bank immediately at 478-272-6262 in Dublin or 912-568-7191 in Alamo.
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