Direct Deposit Authorization
Attn: Human Resources / Payroll Department
Date:
Please acknowledge this letter as my written statement of authorization to change the account information
for the direct deposits I, _______________________________ receive.
I have moved my account to )LUVW National BaQN and the account number you are currently using will no
longer be valid.
Please change my account information as follows:
Bank Name:
First National Bank of Mount Vernon
Bank Address
P.O. Box 909, Mount Vernon, TX 75457
Routing Number
111904192
Name(s) on Account:
_______________________________________________
New Account Number: _______________________________________________
Account Type
 Checking
 Savings
If you have any questions in this matter, please feel free to contact me. Thank you for your assistance
with this.
I hereby authorize this change.
_____________________________________________
_____________
_________________
Account Holder Signature
Date
Phone Number