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

Automatic Payment Change 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 I currently have my payment on the above referenced account automatically withdrawn from my checking/savings account # with Bank on the day of the month.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 transfer this monthly transaction to my new bank, FNB Bank, Inc., and submit this letter as written notification of that intention.

 

I am enclosing an automatic payment authorization form that authorizes you to begin this withdrawal from my FNB Bank account.

 

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