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Sample letter to cancel automatic payment withdrawal

Description

Use this form when you need to cancel a contract. This template contains verbiage to stop automatic charges to a bank account or fund. Simply fill out of the relevant blanks and send the letter.

CANCELLATION LETTER

Date _________________________

Dear _________________________,

I am writing to inform you of a change with regard to my automatic payment withdrawal regarding account number _________________________.

Currently my _________________________ payment is automatically withdrawn from my account #

____________________ held at _________________________. The automatic payment withdrawals are made on the ______________ day(s) of the month.

I hereby notify you of the cancellation of the authorization for the above referenced automatic payment withdrawals.

I understand that I need to give you at least two weeks notice prior to the next scheduled transaction.

Therefore, I expect the last automatic payment withdrawal to be dated  _____________________.

Thank you for your prompt attention to this request.

(Name of Vendor)

(1st, 15th, other)

(Date of Last Transaction)

(Name of Vendor)

__________________________________

__________________________________

__________________________________

(Name)

(Street Address)

(Telephone Number)

(City, State, Zip)

(Signature)

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