1. Date
2. Financial Institution
3. Address
4. City, State, Zip

To whom it may concern:

This notice serves as a request and authorization to close the accounts listed below:

1. Checking Account(s)
2. Savings Account(s)
3. CD Account(s)
4. Close Now
5. Close at Maturity

With my signature, I authorize you to release the funds in the form of a check, made payable as indicated below, for the balance(s) in the above referenced accounts.

If you have any questions regarding this request please contact me during the day or evening at

1. Phone Number

Thank you,

Check Information

1. Customer SignatureX________________________________________
2. Printed Name & Date
3. Joint Signature if ApplicableX________________________________________
4. Address
5. City, State, Zip

Print this form: Complete, sign and submit it to the appropriate business to change any existing direct deposits to your Raymond Federal Bank account. You can call the Social Security office from any RFB branch location to change SSA/SSI deposits.