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  • OK Transfer FROM Account is required
  • OK Transfer TO Account is required
  • OK Transfer Amount $ is required
  • Type of Transfer

    OK Type of Transfer is required
  • Transfer Frequency (pick one)

    OK Transfer Frequency (pick one) is required
  • Start Date

    OK Start Date is required
  • Optional OK Additional Comments is required
  • OK Security Code is required
  • I/we hereby authorize Washington Savings Bank to transfer funds between the above referenced accounts in the amount and frequency indicated. I/we recognize that if there are insufficient funds in the account from which the funds are to be withdrawn to complete the transfer that the transfer will not occur and that an insufficient funds fee may be assessed. I further acknowledge that this transfer will continue until such time as the donor account is closed or this authorization is revoked in writing.

  • I hereby authorize Washington Savings Bank to update/change their official records to reflect the above information. I recognize that these updates/changes will only be made for accounts as they are listed above.

  • OK Signature is required
  • OK Mother's Maiden Name or Account Code is required