Automatic Payment or Withdrawal authorization change.
(Use this form to change automatic payments or withdrawals such as loan payments, insurance payments, transfers to brokerage accounts and etc.)
Please accept this letter as authorization to change the bank account information for automatic payments or withdrawals in the name of ___________, customer account number __________, payment type ____________________, with the approximate amount of transfer of $ __________.
I am aware that some automatic deposits require advance notice of changes. Please consider those notice periods when determining the new effective date.
Effective immediately, the new bank information is as follows:
Friend Bank account number:
My new bank account number is: ______________________________
My new bank routing number is 062102221.
If available, attached is a voided check from my account.
If you have questions, please call me at ____________________. Please send me written confirmation of when the change will be effective. Thank you.