Agency Name: Org #:
Mailing Address:
Agency Contact Name:
Contact Email Address:
Phone: Fax:
Depository Name:
Account Name:
ABA: Account #:
Effective Date of this Request:
WVSTO Use Only
The subject request has been reviewed and is approved by the WVSTO.
Account closing verified at bank by:
Title
Mail To:
West Virginia State Treasuer's Office
Attn: Cash Management - Outside Bank Accounts
322 70th Street SE
Charleston, WV 25304
Phone Number: 304-558-3599
Fax Number: 304-340-1511
Title
Approved By
Date
Name
Date
West Virginia State Treasurer's Office
Division of Cash Management
Request to Close an Outside Bank Account
Signature of Requestor
Date