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Currently my _________________________ payment is automatically withdrawn from my account #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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