WEB CONNECT ADDRESS CHANGE FORM

It is very important that we receive a signed authorization to change the address on your Kemba account. This can be done by a primary or joint owner of the account.

Please print out the following form, complete, sign, then either fax to 513-762-1605 or mail to:

We cannot accept through email since it is not secure.

Please complete the section below.

ACCOUNT INFORMATION
___________________________________ Primary Member	___________________________________ Social Security Number
___________________________________ Joint Member	___________________________________ Social Security Number
___________________________________ Account Number
Should we also change the joint address information on this same account?
Yes - Change Joint     No - Don't Change Joint

OLD ADDRESS	NEW ADDRESS
______________________________________ Street	______________________________________ Street
______________________________________ City	______________________________________ City
______________________________________ State	______________________________________ State
______________________________________ Zip	______________________________________ Zip
______________________________________ Telephone Number	______________________________________ Telephone Number
______________________________________ Written Signature