Switching Banks Made Simple Page 5
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5Direct Deposit Change Request Form
To:____________________________________________________
From:__________________________________________________
Date:___________________________________________________
Please accept this request as notification and authorization to change/establish my automatic payment to my
account held at:
Lewisburg Banking Company
287 N Main Street
PO Box 278
Lewisburg, KY 42256
Name on Account:__________________________________
Type of Account: _______ Checking
________Savings
Account Number:____________________________________
Bank ABA/Routing Number: 083905342
_________________________________________
____________________________________
Customer Signature
Date
_________________________________________
____________________________________
Bank Representative Signature & Title
Date
Attached is a copy of a voided check.
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Parent category: Legal