Bank Account Authorization

Bank Account Authorization Form

I, ________________________________, residing at ___________________________________, in the city of ______________________________ in _____________________________ County, in the state of ___________________, do hereby swear and depose as to the following information:

That I am the sole account holder of account number ____________________ at __________________ Bank. While I am _______________________________________________, I am granting temporary account access to my _________________________, __________________.

I would like to grant __________________________ the power to make deposits of any amount to the account. He/she may also make withdrawals, transfers, purchase orders, or money checks up to $_______________ in a _______-month period. I have a safety deposit box, number _________, which I do not permit access to.

This temporary authorization shall begin on ________________ and end on ______________ unless I notify you otherwise. I may be contacted at __________________________ for further information.

______________________________
Signature and date

______________________________
Witness

Address ____________________

City, state, ZIP ____________________

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