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Request Form for Bank Account, Debit, Charge and Credit. Use this sample letter to tell your bank or credit union that you found a payment taken out of your bank account that you did not authorize.You can let Chrome fill out forms automatically with saved info, like your addresses or payment info. Section 4 Provide the name of the Company employee to be removed and the last four digits of that employee's social security number. •. This checklist can help identity theft victims clear up their records. Customer Removal Authorization Form Authorizes Capital One to remove an existing account holder from an opened account. See Credit or debit card under How To Pay the Tax, later, for more information. See Credit or debit card under How To Pay the Tax, later, for more information. Sends you a bill that explains how much you owe (Notice and Demand for Payment); and. You: Neglect or refuse to fully pay the debt in time.