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Submit this form to any company or payee who is currently making automatic debits from your previous Checking or Savings Account. (You may reuse this form as many times as Submit-this-form-to-any-company-or-payee-who-is-currently-making-/' class='doin' >necessary.) Please Print





Submit this form to any company or payee who is currently making automatic debits
from your previous Checking or Savings Account. (You may reuse this form as many
times as Submit-this-form-to-any-company-or-payee-who-is-currently-making-/' class='doin' >necessary.)

Please Print

Name
Address
City State Zip
Phone Number
Company/Payee Name
Account Number

$ Weekly Monthly Quarterly Annually
Payment Amount

I hereby authorize you to redirect future automatic payment withdrawals to my new
IBM Southeast Employees Federal Credit Union account. Please make this change
effective _______________________________ (date).

New Financial Institution Information:
IBM Southeast Employees Federal Credit Union
P.O. Box 5090
Boca Raton, FL 33487
(561) 982-4700 or (800) 873-5100
Routing/Transit Number: 267077627
Account Number _____________________________

Choose One:
Checking Account
Savings Account


X
Signature







Date
C l e a r
F o r m
F i e l d s