Account Closing Request
To Whom It May Concern:
Please close the following account(s) with your institution:
Account # Checking Savings Money Market Other*
Account # Checking Savings Money Market Other*
Account # Checking Savings Money Market Other*
Account # Checking Savings Money Market Other*
*Note:
IRAs and investment accounts often require additional documentation. Contact your former bank for details specific to the account.
These accounts are in the name(s) of:
Primary Account Holder:
Secondary Account Holder:
(if applicable)
Address:
Please send any funds remaining in these accounts to my attention at:
___ the address shown above
___ the following address:
Should you have any questions, please contact me at .
Thank you,
_______________________________________________ _____________
Primary Account Holder Signature Date
_______________________________________________ ______________
Secondary Account Holder Signature Date
(if applicable)
