ACH Draft Form

Customer Name*

Service Address*

Banks Co Utilities Account Number

Financial Institution Name*

Financial Institution Phone Number*

ABA Routing Number*

This is the first set of numbers on checks

Bank Account Number*

Notice: ACH Draft always occures on the 15th of every month, unless its a holiday or a weekend, it will draft the next business day. ACH Draft also takes 2 full billing cycles to cycle through, please make sure to pay the next 2 bills as you normally do.

Please upload a clear and legible copy of a voided personal check or bank verification showing your account number and bank routing number. This form will not submit without it.

File Upload*

I understand that if i change or close my bank account with the financial intitution listed on this authorication, i must immediatley norify Banks COunty Utilites and sign and submit a new ACH Form.

I understand that I will continue to recieve my regular monthly billing statement by mail or email, which will indication my monthly payment as normal and "PAID BY DRAFT" to inform of the draft day.

I understand that it is my responsibility to maintain sufficient funds in my bank account on the day of the draft. In the event my bank returns the draft due to insuffiecient funds, the County will apply a $30.00 nonpayment fee to my water or sewer account. The payment, including any late fees, must then be made immediatley by another payment method.

Signature*