Automatic Payment (Draft) Change Authorization

To: Business Name _______________________

Attn: Accounts Payable

Business Address _____________________

Business City/State/Zip __________________________

Business Customer Service Number ________________

From: The First Customer Name____________________________________

Date: ____________________________________

RE: Change of Monthly Debit to New Checking Account at The First

New Checking Account Number: __ __ __ __ __ __ __ __ __

New Routing/Transit Number 065303360

Effective immediately, please debit our agreed-upon amount from the above-referenced checking account number.

For your reference, my account Number with your business is

__________________________

New Bank Information:

The First, A National Banking Association

Post Office Box 15549

Hattiesburg MS 39404

___________________________ ______________ _________

Signature of customer Social Security Number Date

___________________________ ________________

Printed Name Daytime Telephone Number

____________________________________________________________

Address, City, State, Zip