FNB Bank, Inc.
101 East Broadway
Mayfield, KY 42066

Automatic Payment Cancellation Request

Date:

 

 

 

 

To:

 

 

 

 

Address1:

City:

 

 

Address2:

State:

Zip:

 To Whom It May Concern:

I am writing to you of a change in my banking relationship concerning my account # . I currently have my payment on the above referenced account automatically withdrawn from my checking/savings account # with Bank on the day of the month.

 I would like to cancel these monthly transactions, and submit this letter as written notification of that intent.

 

Thank you for your prompt attention to this matter. If you require further information, you may contact me at:

 

Name:

 

 

 

 

Address:

 

 

 

 

City:

State:

 Zip:

Phone:

Email:

 

_________________________________       _______________________

Signature of account holder                                Date

 

_____________________________________

Second Signature (If Joint Account)

 Print this form out first then sign and date and return to us at:

FNB Bank, Inc.

101 East Broadway

P.O. Box 369
Mayfield, KY 42066-0029