Community Financial Credit Union

Dormant/Inactive Account
Transaction 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):

Account Number:
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):

Transaction Requested on Account
Deposit $
Withdrawal $
Transfer $
From Account
Name on Account
To Account
Name on Account


Signature ________________________________________ Date ___________________