Form Exchange Form 6450 Exchange Form 6450 Exchange Credit Program

OMB NO. 0702‐XXXX 
OMB approval expires 
MMM DD, YYYY

EXCHANGE CREDIT PROGRAM
ACCOUNT UPDATE
FOR EXCHANGE USE ONLY
Date Received HQ

I.D. Verified By:  
Local Store

(Initials)

Please read the Agency Disclosure Notice at the bottom of this page and the Privacy Act Statement on reverse prior to
completion of the below application. Be certain to read and follow all instructions provided when completing this form.

CUSTOMER INFORMATION (Please print all information)
a. Account Number (Social Security No. may be used)

c

b. Full Name on Account (Last, First, Ml)

H
A
N
G
E

e. CHANGE Home Address To (Street, Box, City, State and Zip)

T

d. Home Address (Street, Box, City, State and Zip)

c. CHANGE Name To (For Name Changes Only)

f. Home Phone

AF

s

g. CHANGE Home Phone To

h. Work Phone

i.

CHANGE Work Phone To

AUTHORIZED USER INFORMATION (Select the appropriate option below by initialing option.)

 I understand that authorized users are required to be 1) a family member or the account holder, 
2) 18 years of age or older and 3) that I am responsible for all transactions made by them. 

R

j.

OPTION A – I AUTHORIZE the following
individual(s) to use my:

  MILITARY STAR Card account ONLY 

D

OPTION B – I WITHDRAW AUTHORIZATION
From the following individual(s) to use my:
MILITARY STAR Card
MILITARY STAR Rewards
MasterCard account
Both MILITARY STAR Card & MILITARY STAR
Rewards MasterCard accounts. **

Both MILITARY STAR Card & MILITARY STAR Rewards
MasterCard accounts.*
*To ADD an authorized user to your MILITARY STAR Rewards MasterCard account, they must be ADDED
as an authorized user to your MILITARY STAR Card account.
**To REMOVE an authorized user from your MILITARY STAR Card, they must be REMOVED from your
MILITARY STAR Rewards MasterCard.
1. Family Member Name (Last, First, Ml)

Relationship

DOB: (dd mmm yyyy)

Social Security No. (authorized user)

2. Family Member Name (Last, First, Ml)

Relationship

DOB: (dd mmm yyyy)

Social Security No. (authorized user)

ACKNOWLEDGMENT - The information furnished on this update form is true and correct to the best of my knowledge. I understand that use of any account in connection with
this form is subject to the terms and conditions of the EXCHANGE CREDIT PROGRAM AGREEMENT.
I. ACCOUNT HOLDER SIGNATURE REQUIRED:

m. DATE: (dd mmm yyyy)

AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information is estimated to average 6 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the
Department of Defense, Washington Headquarters Services, Executive Services Directorate, Directives Division, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100 (0702-XXXX). Respondents
should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR RESPONSE TO THE ABOVE ADDRESS.
Responses should be sent to your local Exchange retail facility, to the Exchange office whom provided you the application or the update, or to the Exchange Military Star at the Army and Air Force Exchange Service, 3911 South
Walton Walker Blvd., Dallas, TX 75236-1598.

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PRIVACY ACT STATEMENT 

AUTHORITY:  Title 10 U.S.C. §3013, “Secretary of the Army”; “Federal Claims Collection Act of 1966” (Pub. L. 89‐
508, as amended); “Debt Collection Act of 1982” (Pub. L. 97‐365, as amended); 31 CFR 285.11, “Administrative 
Wage Garnishment”; DoD 7000.14‐R, “Department of the Defense Financial Management Regulation”; Army 
Regulation 215‐8/AFI 34‐211(I), “Army and Air Force  Exchange Service Operations”; and Executive Order 9397 
(SSN), as amended.   

PRINCIPAL PURPOSES(S):  These forms collect personal information mandatory to process and provide the basis 
of approving participation in the Exchange Credit Program.  

ROUTINE USE(S):  Your records may be disclosed outside of DoD pursuant to Title 5 U.S.C. §552a(b)(3) regarding 
DoD “Blanket Routine Uses” published at 
http://dpcld.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx.  This includes disclosure To the 
Department of the Treasury, and a debt collection agency with which the United States has contracted for 
collection services to recover debts owed to the United States. To any employer (person or entity) that employs 
the services of others and that pays their wages or salaries, where the employee owes a delinquent nontax debt 
to the United States.  The term employer includes, but is not limited to, State and local governments, but does 
not include any agency of the Federal Government.  To consumer reporting agencies pursuant to 5 U.S.C. 
552a(b)(12) as defined in the Fair Credit Reporting Act (14 U.S.C. 1681a(f)) or the Federal Claims Collection Act of 
1966 (31 U.S.C. 3701(a)(3)). The purpose of this disclosure is to aid in the collection of outstanding debts owed to 
the Federal government; typically to provide an incentive for debtors to repay delinquent Federal government 
debts by making these debts part of their credit report.  The disclosure is limited to information necessary to 
establish the identity of the individual, including name, address, and taxpayer identification number (Social 
Security Number); the amount, status, and history of the claim; and the agency or program under which the 
claim arose for the sole purpose of allowing the consumer reporting agency to prepare a commercial credit 
report. This disclosure will be made only after the procedural requirement of 31 U.S.C. 3711(f) has been 
followed. 

DISCLOSURE:  Voluntary, however, failure to provide all the requested information may result in the denial of 
your application for inadequate data.  

A copy of the Privacy Impact Assessment (PIA) for this collection may be located at http:  
http://www.aafes.com/about‐exchange/public‐affairs/foia.htm.  

SYSTEM OF RECORD NOTICE:  AAFES 0702.34 “Accounts Receivable Files”; 
http://dpcld.defense.gov/Privacy/SORNsIndex/DODwideSORNArticleView/tabid/6797/Article/570128/aafes‐
070234.aspx