July 01, 2014

Contact Name
Address
City, Province, Zip Code
OBJECT: AUTHORIZATION TO DEBIT ACCOUNT

Dear [Contact Name],

This letter is to acknowledge that [Company/Individual] is hereby authorized
to debit our Account Number [Account Number] in the amount of [Amount] for
payment of [Nature of Debt]. Please withdraw the funds from the following bank
account:
Bank
:
Bank Transit No.
:
Account No.
:
Bank Telephone No.

This shall be your good and sufficient authority for doing so. Thank you and
more power.

Sincerely,
[NAME]
[TITLE]
[PHONE NUMBER]
[YOUR EMAIL OR THE COMPANY]

Prepared by:

Approved by:

Noted by:

D ASIAN HILLS BANK, INC.

(A Rural Bank)
Making a Difference Through Generations
Tel No. (088) 221-4697/ Telefax (088) 813-3990
asianhillsbank@yahoo.com
www.asianhillsbank.com