1. Date
2. Company Making Automatic Payments
3. Address
4. City, State, Zip

To whom it may concern:

Please be advised that I am closing the existing account from which you are authorized to withdraw automatic payments. This notice authorizes you to establish this automatic payment deduction from my Raymond Federal Bank account as of

New Account Information

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 automatic payment to your Raymond Federal Bank account.