AUTHORIZATION TO CLOSE ACCOUNT |
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| Previous Financial Institution: | __________________________________________ |
| Address: | __________________________________________ |
| This form gives you authorization to close my account #__________ and forward the balance to us at the address provided. Please make the check payable First National Bank for benefit of (Name): | |
| Name: | __________________________________________ |
| Your prompt attention to this request is appreciated. Thank you. | |
| Signature: | __________________________________________ |
| Date: | __________________________________________ |
| Joint Signature: | __________________________________________ |
| Date: | __________________________________________ |
First National Bank |
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