Change Automatic Withdrawal
Please complete, print, sign and submit this form to the appropriate financial institution.
Date
Name of company that makes automatic withdrawals

Address
City, State Zip ,
   
To Whom it May Concern:  
You are currently withdrawing $
for my loan, insurance, etc
From:
  Checking or Savings account (choose one)
  Account # or other identifying #
Checking  Savings
On Month/Day (MM/DD) of withdrawal:
from the following account:  
Old Bank
Bank Routing #
Account #
   

Please stop making withdrawals from that account and instead make them from:
Sterling Savings Bank
Bank Routing #
Account #
   

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:

Phone (Area Code, Phone #)   
   
Thank you, Sincerely  
Signature (please print form and sign here)
Name
Address
City, State Zip ,