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Get Canada Name Change Authorization Form

document(s) issued by a provincial or territorial government authority in Canada evidencing the name change. For examples of supporting documents please see back page. You must complete a separate form for each account affected by the name change. Forms may be submitted together with one copy of the supporting documentation. ACCOUNT INFORMATION Account Type: [ ] Credit or Charge Card Account Number: Who is the name change request for? [ ] Basic Cardmember BASIC CARDMEMBER INFORMATION Origi.

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