Transfer Your Account to Peoples Bank

Name ________________________________________________________________________________________

Address ______________________________________________________________________________________

City/State/Zip ______________________________________ Phone ___________________________________

New Phone Number ___________________________________________________________________________

Email Address ________________________________________________________________________________

List below the automatic payments you currently have taken out of your account:

Paid to:
____________________________________________
____________________________________________
____________________________________________
____________________________________________

Amount:
____________________________________________
____________________________________________
____________________________________________
____________________________________________

List below the automatic deposits you currently have coming into your account:

Received from :
____________________________________________
____________________________________________
____________________________________________
____________________________________________

Amount:
____________________________________________
____________________________________________
____________________________________________
____________________________________________