Payment Cancel Request
Fill Out Form, Print and Provide to Vendor.


Dear

I am writing to inform you of a change in my banking relationship concerning my account number .

I currently have my payment automatically withdrawn from my checking/savings account # on the of the month. I would like to cancel these monthly transactions, and submit this letter as written notification of that intention.

I understand I need to give you several days/weeks notice prior to the next scheduled transaction. Therefore, I expect the last transaction from to be the one dated .

Thank you for your prompt attention to this request.

Sincerely,