Automatic Withdrawal Form

 

If you have regularly scheduled automatic withdrawals from your current account, you will want to notify the
organizations generating those withdrawals that you have changed your bank account information. This form
will assist you with that task.
Please complete, sign and submit this form to the appropriate company/agency.

 

__________________________________________________________________________
Company/Agency Name

___________________________________________________________________________
Address City State Zip

Effective immediately, please use my new account to process my automatic withdrawal.

 

___________________________________________________________________________
Name

 

___________________________________________________________________________
Address City State Zip

Daytime phone #___________________________________________________

Old Account #______________________

My new bank is Manhattan Bank

New Account #_____________________________________ Type ____ Checking ___ Savings
Routing Transit # 092902132

 

_______________________________________________________ ______________________
Signature Date

Please note:
If you are transferring your account from another financial institution, it is recommended you maintain
accounts at both banks until your automatic withdrawal transfer has been completed.
Please contact the organization that generates your automatic withdrawal for the date when the transfer will
be effective. Additional forms or information may be required to complete the transfer.