UMass Five College Federal Credit Union, Amherst Mass


ATTENTION: If the authorized user you wish to remove is a joint owner on the account, you cannot use this form and must contact the Credit Union at (800) 852-5886.
* Required field
Your Information
Prefix
*First Name
Middle Name
*Last Name
Suffix
*Member Number Not sure? Click here
*Social Security Number
*Mother's Maiden Name
*Daytime Phone
*Home Phone
Fax Number
*Email Address
*Credit Card Number

Authorized User to be Removed
Prefix
*First Name
Middle Name
*Last Name
Suffix
Address
City
State
Zip
Social Security Number
I hereby acknowledge that the above named person is not a joint owner on this account, and request that they be removed as an authorized user.

	If submitting electronically, no signature is required.
You can also print this form and send it to the Credit Union by any of the following methods: Mail: PO Box 1060, Hadley, MA 01035 Fax: 413-253-0183 Drop it off at your local branch If mailing, faxing or dropping off this form please sign and date the form below.
Signature	__________________________
Date	__________________________
If you have questions and would like to speak to someone, please call our Member Contact Center at 1-800-852-5886 during normal business hours.



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