Account Change Type
*
Add Account Holder
Add Beneficiary
Request To Close Account
Personal Information
Your Name
*
First
Last
Email Address
*
Account Number
*
Add Account Holder
Add Beneficiary
Request To Close Account
Name
*
First
Middle
Last
Social Security Number
*
Citizenship Status
*
US Citizen
Resident Alien
Non-Resident Alien
Date of Birth
*
Month
1
2
3
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5
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7
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12
Day
1
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31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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2004
2003
2002
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1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Picture ID Type
*
Driver's License
U.S. Government Issued ID
Military ID
Passport
Passport Card
Picture ID Number
*
Picture ID State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ID Expiration Date
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
Home Phone
*
Work Phone
Cell Phone
Email
*
Enter Email
Confirm Email
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Occupation
*
Please Select One
Attorney
Bar/Restaurant
Casino
Charitable Organization
Chruch
Construction/Contractor
Convenience Store
Grocery Store
Farm Implements Dealer
Imports/Exports
Jewelry Store
Leather Goods
Medical Supply Sales
Securities Broker/Dealer
Vehicle Dealer/Dealership
Other (see below)
Other Occupation
Non-Interest Bearing Checking Accounts
- Simply write a check to bring your account to a zero balance and your account will be closed. You do not need to submit this form.
Certificate of Deposit
- Original CD must be presented to the bank in order to cancel a CD. Please do not submit this form.
Heritage Direct Savings Account
- Please submit this form and Heritage Bank will transfer your account balance plus accrued interest into your linked checking account. This transfer may take up to three days to post to your account. If you’re closing your account within the first 6 months of opening there will be a $30 closing fee.
All Other Deposit Accounts
- Please choose from the following options for how you would like to receive the account balance plus accrued interest and submit this form. If you’re closing your account within the first 6 months of opening there will be a $30 closing fee.
Heritage Bank will transfer account balance to your linked checking account (Heritage Direct only)
Heritage Bank will transfer account balance to another Heritage Bank account
Mail me a check (not available for Heritage Direct accounts)
Account Number
*
Reason for Closing Account
*
Please provide a copy of the new account holder's unexpired ID to any of our Heritage Bank locations.
If you would like to add an additional account holder please submit another request.
We will be in contact with you once we have processed your request.
If you would like to add an additional beneficiary, please submit another request.
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