Residential Application for City of Durant Utilities

Would you like to provide a copy of a valid ID and lease agreement or property deed at this time?

Yes, I would like to upload them from my documents Yes, I would like to take take a picture with my camera No, Please contact me later to receive these

Take Photo of your ID

Take Photo of your Lease or DEED

Take Photo of your Lease or DEED page 2

Take Photo of your Lease or DEED page 3

Take Photo of your Lease or DEED page 4

Take Photo of your Lease or DEED page 5

Take Photo of your Lease or DEED page 6

Upload a copy of your ID, Lease Agreement or Deed

Would you like to sign up for auto pay? *

Yes - Draft my bank account No

Financial Institution Information

Name of Financial Institution

Branch

City State

Zip Code

Phone Number of Financial Institution

Checking or Savings Account

Checking Savings

Routing Number

Account Number

Name on account

First Name Last Name

I (we) hereby authorize City of Durant Utility Authority, hereinafter called COMPANY, to initiate debit entries to my (our) account indicated below at the depository financial institution named above, hereafter-called DEPOSITORY, and to debit the same to such account. I (we) acknowledge that orgination of ACH transactions to my account must comply with the privisions of U.S. law. I (we) further authorize COMPANY to inititate credit entries to my (our) account for the sole purpose of correcting any debit entries that were previously initiated in error or for an incorrect amount.

Signature

Clear

Copy of Voided Check

Type of Card

Visa Master Card

Credit Card Number

Exp. Date

Security Code

Name of Card Holder

First Name Last Name

Address of Card Holder

Street Address

Street Address Line 2

City State

Zip Code

I (we) authorize Durant City Utility Authority, hereinafter called COMPANY, to initiate credit card transactions to my (our) credit card indicated below with the credit card named below. I further authorize COMPANY to initiate credit card entries to my (our) account for the sole purpose of correcting any credit card entries that were previously initiated in error or for an incorrect amount.

Signature

Clear

Copy of Credit Card to verify correct information