11/04
Date:
Credit card issuer’s name:
Credit card issuer’s address:
Credit card account number:
To Whom It May Concern,
Effective this date, please close the above account. Enclosed is a credit union check in the amount of
$____________________ to be applied towards the account balance. If applicable, enclosed is the destroyed
credit card(s) or complete payoff of my account. University Federal Credit Union is only responsible for paying the
amounts quoted by me or as shown on my billing statement. Please bill me directly for any remaining balance
due which may be a result of additional charges on my account or additional finance charges owing.
Signature
Date
Authorization to Close Credit Account