Complete this form for each account you are requesting to be closed. Make additional copies as needed.

Account Closure Request

Close the accounts at your former financial institution.
Start using your new This account closure request allows you to specify the date you want
Union Bank accounts your former account closed and where you want your remaining
exclusively. balance sent.

Three Simple Steps Today’s Date:

1 Complete this form. Name of Former Institution:

2 Ensure your new Union Bank Former Account Number:

account is active before you
Address:
close your existing account.
City, State, Zip Code:
3 Send this form to your former
institution after all your Effective as of (Date):
existing checks, deposits,
direct deposits, automatic You may choose to have funds from your former account wired or sent via cashier’s check.
payments, and pre-authorized Select option A or B below.
transfers have cleared. Once all
these items have cleared, you’re A) Close the account noted above and wire the balance and any interest accrued to:
ready to close your former
Union Bank Account Information
account.
Union Bank Account Type: Checking Savings Money Market
For assistance, call Union Bank
at 1-800-238-4486, Monday-Friday, Union Bank Account Number:
from 7:00 a.m. to 9:00 p.m., and
Saturday, from 8:00 a.m. to 5:00 p.m.
Union Bank ABA Routing Number: 122000496
(Pacific Time).
B) Close
 the account(s) noted above in the name of
and send a cashiers’s check for the remaining balance to the address below.

First Name:
Note: Your former bank may
Last Name:
charge you a fee for fulfilling
this request. Address:

City, State, Zip Code:

Phone Number: ( ) - -

Primary Accountholder’s Signature Date

Joint Accountholder’s Signature Date

84705-C (12/11)