Account Ownership Transfer Form

"*" indicates required fields

Account Information

Hidden

Jira Issue Key*

Account Type*

Account Number*

Name*

Address*

Street Address Address Line 2 City State Zip Code

Hidden

Accounts*

Account Type

Account Number

Name

Address

New Owner Information

Full Name*

First Last

Email*

Enter Email Confirm Email

Phone Number*

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Payment

A fee is required to transfer the account to a new owner.

Account Transfer Fee

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address*

Street Address Address Line 2 City State Zip Code

Approval

Authorization of the transfer of ownership requires the new owner to provide proof of ownership enter and confirm their full name in the "Signature" section below. Clicking "Authorize" will send the form to Card Concepts Inc. and initiate the account transfer.

Proof of Ownership*

Please provide any documents that show the new owners name associated with the business address CCI has on file.
Examples include bill of sale, tax form, utility bill, etc.

Drop files here or

Max. file size: 512 MB, Max. files: 5.

Date of Ownership Transfer*

Additional Notes

Signature*