et Prepared with
The
Simple Planner
______________________________________________
Citizens Bank & Trust Checking Account Number
_______________________________________________
Citizens Bank & Trust Savings Account Number
_______________________________________________
Citizens Bank & Trust Routing Number
Company Name
Date Form Sent
Estimated Switch Date
(Approx. 60 Days)
Direct Deposit
Automatic Withdrawals
Outstanding Transactions
Payable To
Check
Number
Amount
Date
Created Get Prepared with
The
Simple Planner
Authorization of
Direct Deposit
Three Easy Steps:

1. Complete, sign and date this form

2. Attach a voided check from your new
Citizens Bank & Trust
account

3. Submit a copy of this form to each company or/and organization that is

currently depositing into your account
Company Name:___________________________________________
Company Address:__________________________________________


__________________________________________
To Whom It May Concern:
I,_______________________, recently changed banks and request that my
direct deposits be switched to my new account at
Citizens Bank & Trust
of
Florida. My information is below:
Name on account:____________________________________
Address:____________________________________________

___________________________________________
Phone Number:______________________________________
Please switch my direct deposits to this account:
checking
or
savings







(Circle checking or savings)
Citizens Bank & Trust
Checking Account Number:____________________
Citizens Bank & Trust
Savings Account Number:_____________________
Citizens Bank & Trust
Routing Number:_____________________________
Effective:____/____/_____

Address: Post Office Box 3400,







Lake Wales, FL 33859
If you have any other questions please contact me:
______________________ ______________________ ____________

Signature

Printed Name

Date

Track your request
and follow-up with
online banking at
www.citizens-bank.com

Reminder:
VA and Social
Security
Administration
direct deposits need
additional forms. For
your convenience,
Citizens Bank &
Trust will help you
with your VA and
Social Security
direct deposit. Just
come into your local
branch and see a
Customer Service
Representative and
we will sit down,
make the calls, and
do your paperwork
together.
OR
You can call:
VA: 1-877-838-2778
SS: 1-800-772-1213

For more than
one deposit please
print additional
Authorization of
Direct Deposit forms. Authorization of
Automatic Withdrawals
Three Easy Steps:

1. Complete, sign and date this form

2. Attach a voided check from your new
Citizens Bank & Trust
account

3. Submit a copy of this form to each company or/and organization that is

currently withdrawing from your account
Company Name:___________________________________________
Company Address:__________________________________________


__________________________________________
To Whom It May Concern:
I,_______________________, recently changed banks and request that my
automatic withdrawals be switched to my new account at
Citizens Bank &
Trust
of Polk County, Florida. My information is below:
Name on account:____________________________________
Address:____________________________________________

___________________________________________
Phone Number:______________________________________
Please switch my withdrawals to this account:
(circle one)

checking
or
savings








Citizens Bank & Trust
Checking Account Number:____________________
Citizens Bank & Trust
Savings Account Number:_____________________
Citizens Bank & Trust
Routing Number:_____________________________
Effective:____/____/_____

Address: Post Office Box 3400,







Lake Wales, FL 33859
If you have any other questions please contact me:
______________________ ______________________ ____________

Signature

Printed Name

Date

Track your request
and follow-up with
online banking at
www.citizens-bank.com

Reminder:
Many companies
and organizations
require special forms.
Contact and check
with them to make
sure there are no other
requirements.

For more than one
automatic withdrawal
please print additional
Authorization
of Automatic
Withdrawal forms. Authorization of
Automatic Withdrawals
Authorization of
Account Closure
Three Easy Steps:

1. Complete, sign and date this form

2. Send this form to your former bank after all of the authorizations are made and

are switched to your new
Citizens Bank & Trust
account.
Former Bank Name:___________________________________________
Former Bank Address:__________________________________________


___________________________________________
To Whom It May Concern:
I,_______________________, would like to close my bank account(s)
at______________________. Please make this effective as of
___/___/___.
Please send remaining balance as an Official Check to:
Name:__________________________________________
Address:________________________________________
________________________________________
Account 1:
Name on account:____________________________________
Account Number:__________________________
(Circle one)
checking
or
savings
or
money market
Account 2:
Name on account:____________________________________
Account Number:__________________________
(Circle one)
checking
or
savings
or
money market
If you have any other questions please contact me:
______________________ ______________________ ____________

Signature

Printed Name
Date
______________________ ______________________ ____________

Signature

Printed Name
Date

Reminder:
Make sure all
outstanding checks,
deposits, and
withdrawals have
cleared before
closing your
account.

For more than
two accounts, please
print additional
Authorization
of Closure of
Accounts. Auburndale
111 Havendale Blvd.
Auburndale, FL 33823
863-967-2781
Bartow
1450 N Broadway Ave
Bartow, FL 33830
862-533-6472
Chalet Suzanne Road
Lake Wales
23725 Highway 27
Lake Wales, FL 33859
863-676-0988
Dundee
1013 State Road 542 W
Dundee, FL 33838
863-439-2946
Frostproof
2 East Wall Street
Frostproof, FL 33843
863-635-2244
Haines City
36250 Highway 27
Haines City, FL 33844
863-421-8484
Indian Lake Estates
6481 Deland Avenue
Indian Lake, FL 33855
863-692-1386
Lake Wales
222 State Road 60 East
Lake Wales, FL 33853
863-676-7631
Lakeland- Downtown
122 E. Pine St.
Lakeland, FL 33801
863-686-1430
Lakeland Edgewood
1959 E. Edgewood Dr.
Suite 102
Lakeland, FL 33803
863-686-1346
Winter Haven
1120 First Street South
Winter Haven, FL 33880
863-291-3319
Winterset at High Pointe
Winter Haven
6340 Cypress Gardens Blvd.
Winter Haven, FL 33884
863-324-4720
Hours and Locations
LOBBY HOURS:
MondayThursday:
8:30 a.m. to 4 p.m.
Friday
8:30 a.m. to 6 p.m.
DRIVE-THRU HOURS
MondayThursday:
8 a.m. to 5:30 p.m.
Friday
8 a.m. to 6 p.m.
Saturday: 8:30 a.m. to 12 noon
(Auburndale, Frostproof,
Lake Wales, Haines City,
WH Cypress Gardens Blvd.)
INDIAN LAKE ESTATES
HOURS
Monday & Wednesday
10 a.m to 2 p.m.
Friday
10 a.m. to 4 p.m.
BARTOW & LAKELAND HOURS
(LOBBY ONLY)
Monday to Thursday
8:30 a.m. to 5 p.m.
Friday
8:30 a.m. to 6 p.m.