Preauthorized Automatic Payment Change

To whom this may concern:

 

Due to a recent change in my/our banking relationship I/we authorize the change of the preauthorized automatic payment(s) from my old checking account to the new checking account held at First Star Bank.  Please find the necessary information to fulfill this request below:

 

This is in reference to the account I hold with your company:

 

Company Name: ______________________________________________________________________

                                                               

Account number (if applicable): ___________________________________________________________

 

Account Owner(s) Name: ________________________________________________________________

 

Account owner(s) Address: _______________________________________________________________

 

Daytime Phone Number: __________________________________________________________________

 

Text Box: I hereby authorize any future automatic payments to be taken from my new checking account at First Star Bank          I
 

 


 

 

 

First Star Bank/ABA Routing Number:  231371786

 

New Account Number: ____________________________________________________________________

 

Please discontinue making payments from my/our previous account:

 

Previous Financial Institution: _________________________________________________________________

 

 

 

Please send written confirmation of this change, along with effective date, to the address listed above.

 

Signature: ____________________________________________   Date: _______________________________

                

Signature: ____________________________________________    Date: _______________________________                               

 

*You are responsible for the accuracy of the information you provided to your affected contacts.  First Star Bank has no control over the amount of time it will take your contact to process your request so you should plan interim payments accordingly.