Change of Address Form

• Name
  OK Name is required
• Social Security Number
  OK Social Security Number is required

Accounts affected by this change request

• Checking (Enter Account Number)
  Optional OK Checking (Enter Account Number) is required
• Savings or Christmas / Vacation Club (Enter Account Number)
  Optional OK Savings or Christmas / Vacation Club (Enter Account Number) is required
• CD's or IRA's (Enter Account Number)
  Optional OK CD's or IRA's (Enter Account Number) is required
• Loans (Enter Account Number)
  Optional OK Loans (Enter Account Number) is required

• Grant County Bank ATM Card

  • Yes
  • No
  OK Grant County Bank ATM Card is required

• Grant County Bank VISA Check Card

  • Yes
  • No
  OK Grant County Bank VISA Check Card is required
• Other Accounts (Enter Account Type and Number)
  Optional OK Other Accounts (Enter Account Type and Number) is required

Existing Information

• Name
  OK Name is required
• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required
• Phone
  OK Phone is required

Corrected / Changed Information

• Name
  OK Name is required
• Address
  OK Address is required
• City
  OK City is required
• State AK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
  OK State is required
• Zip
  OK Zip is required
• Phone
  OK Phone is required

Security Code

• OK is required

I authorize the address/phone number changes listed. They are to apply to accounts or other banking relationships listed above. I understand that accounts not listed will not be changed. I certify that I am entitled to receive mail and official correspondence from the bank accounts listed. I am the legal owner of the account(s) listed above and hereby authorize Highlands Bank to modify the information as requested above.