Account Closure Request Form



I:*
Are you the:*
Account Type(s):*
Please select appropriate line below:*
Reason(s) for Account Closure:*
Upload a copy of your Drivers License/or government state-issued ID*
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Please Note: Additional information may be requested in order to process your request.

I have canceled all recurring electronic debits and/or credits associated with the member numbers mentioned above. In the event that there are any pending authorizations that have not yet posted to my account, I understand that I am fully responsible for complete payment of those items. I acknowledge that by including my Savings account (000) in this request, I will be discontinuing my membership with Shell Western States Federal Credit Union (SWSFCU) and will need to re-qualify for membership eligibility.

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Date:*

Member Services

Date:
Expiration Date:

Manager Review

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