Revoke of Authorization | NY, PA ATM Overdrafts

Revocation of Authorization to pay overdrafts on my ATM and everyday debit card transactions.

This form is to revoke my previous authorization for Tompkins to authorize and pay overdrafts on my ATM and everyday debit card transactions.

* Required

Your Name *

, understand that by submitting this form, I am confirming my revocation that Tompkins Community Bank will no longer authorize and pay overdrafts for ATM and Everyday debit card transactions for the following accounts: (Please list each account number separately)

Checking Account Number *

Checking Account Number

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