Form 6450-005 Form 6450-005 Exchange Credit Program Account Update

OMB NO. 0702‐0137 
OMB approval expires 
MMM DD, YYYY

FORM 6450-005 "Account Update"

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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.

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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

f. Home Phone
h. Work Phone

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

AF

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

c. CHANGE Name To (For Name Changes Only)

s

g. CHANGE Home Phone To

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.

j.

OPTION A – I AUTHORIZE the following

OPTION B – I WITHDRAW AUTHORIZATION
From the following individual(s) to use my:

individual(s) to use my:

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  MILITARY STAR Card account ONLY 

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.

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

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

Relationship

DOB: (dd mmm yyyy)

Social Security No. (authorized user)

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)

The public reporting burden for this collection of information, 0702-0137, is estimated to average 2 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 the burden estimate or burden reduction
suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-informationcollections@mail.mil. 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.

FORM 6450-005 "Account Update"

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PRIVACY ACT STATEMENT 
AUTHORITY:  10 U.S.C. 7013, Secretary of the Army; 10 U.S.C. 9013, Secretary of the Air Force; Federal Claims Collection
Act of 1966 (Pub.L. 89-508, as amended) and Debt Collection Act of 1982 (Pub.L. 97-365, as amended), as amended by the
Debt Collection Improvement Act of 1996 (Pub.L. 104-134, section 31001) as codified in 31 U.S.C. §3711, Collection and
Compromise; 31 CFR 285.11, Administrative Wage Garnishment; DoD Instruction 1330.21, Armed Services Exchange
Regulations; DoD 7000.14-R, Department of Defense Financial Management Regulation Volume 13:, “Nonappropriated
Funds Policy” and Volume 16: “Department of Defense Debt Management”; Army Regulation 215-8/Air Force Instruction
34-211(I), Army and Air Force Exchange Service Operations; and E.O. 9397 (SSN), as amended.  

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PRINCIPAL PURPOSES(S): To determine an individual’s credit worthiness, monitor account activity, process account
purchases, payments and/or collections, answer patron’s questions about their account, determine indebtedness and
eligibility to cash checks at Exchange facilities, administer and respond to questions about the Federal Claims Collection
Act, and post to Exchange Accounts Receivable and audit results.

AF

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.

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

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INSTRUCTIONS:


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 Questions should be directed to the Exchange Credit Program Contact Center at 1-877-891-7827.