Account Reactivation Form

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ACCOUNT REACTIVATION FORM

Customer’s Name: _______________________________________________

Account Name: _______________________________________________

Account Number:

Customer Address: _______________________________________________

_______________________________________________

E-Mail: _______________________________________________

Telephone Number:

Date of Birth:

Test Questions

1. Balance in Account _______________________________


2. Last three withdrawals (Date OR Amount) _______________________________
3. Address used when account was opened _______________________________
_______________________________
4. When and where was the account opened _______________________________

Customer’s Signature & Date _______________________________

Signature Verified By:

Name _______________________________________________

Account Number

Signature & Date _______________________________________________

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