Revocation of Authorization

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

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

I, , understand that by submitting this form, I am confirming my revocation that Mahopac 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)

Account Number: 

Account Number: 

Account Number: