Letter of Cancellation For Automatic Withdrawal Payment

Date ______________________

Dear _________________________,

This is to inform you of a change to my automatic payment withdrawal regarding my account number _________________________. Currently the _________________________ payment is automatically withdrawn from account # ____________________ held by _________________________. The automatic payment withdrawals are made on ______________ day(s) of the month. I hereby notify you of the cancellation of the authorization for the above listed referenced automatic payment withdrawals. I understand that I need to give you at least __________, notice prior to the next scheduled withdrawl. Therefore, I expect my last automatic payment withdrawal to be dated on _____________________. Thank you for your prompt attention to this request.
(Name of Company) (Date of Last Transaction) (Name of Vendor)

__________________________________ __________________________________ __________________________________
(Name) (Street Address) (Telephone Number) (City, State, Zip) (Signature)

Sign up to vote on this title
UsefulNot useful