Associate Name:
Associate Site:
Daytime Contact Number:
CIF:
Account # to close:
Customer is requesting closure AT MATURITY - Y/N/NA:
Customer is requesting an EARLY closure- Y/N/NA:
CUSTOMER HAS BEEN ADVISED OF EARLY CLOSURE
PENALTY - Y/N/NA:
Maturity Date:
Date of transfer (if different from Maturity Date) - Y or N/A:
Amount to Transfer (EXACT Account Balance + Accrued Interest):
External account verified Y/N:
External Bank Name:
External Routing Number:
FULL External Account #:
External Account Type:
Reason for Closure:
CUSTOMER HAS BEEN ADVISED OF ACCRUED INTEREST- Y/N:
(If Internal) Provide Internal Account Number customer wants to send
interest to:
(If Check) - Provide address or address on file: