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Removal from Auto Draft/Bank Draft

  1. Customer - Account Information

  2. Agreement

  3. Please remove the Customer-Account number listed above from the Auto Draft program.

    I understand this will be effective on my next statement and any current amount owed on the account will still draft on the designated date for the designated amount.

    Type I AGREE in the authorization box below if you agree with the terms stated above.
  4. Leave This Blank:

  5. This field is not part of the form submission.