1. Date
2. Company Making Direct Deposit
3. Address
4. City, State, Zip

To whom it may concern:

Please be advised that I am closing the existing account to which you are authorized to make a:

This notice authorizes you to establish this direct deposit to my Raymond Federal Bank account as of

New Account Information: Raymond Federal Bank

1. Routing Number
2. Checking
3. Savings
4. Account Number

Attached is a voided check for your reference.
If you have any questions regarding this request please contact me during the day or evening at

1. Phone Number

Thank you,

1. Customer SignatureX________________________________________
2. Printed Name & Date
3. Address
4. City, State, Zip
5. Identifying Number
6. SSN
7. Account Number

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.