Utility Billing - Draft Authorization

Utility Billing - Draft Authorization
Checking AccountSavings Account
Name of Bank, Credit Union, or Savings & Loan*
Transit / Routing Number*
Bank Account Number*
Name as it appears on your utility account*

First NameLast Name
Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Utility Account Number*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
I hereby authorize the City of Aledo to execute ACH bank drafts from my utility billing account for monthly payments. I understand that this authority will remain in full force and effect until written notification of termination is received. I understand that nothing in this authorization shall serve to reduce my obligation to pay my utility bill. I also understand that I will be charged a $35 fee and services may be disconnect shall I fail to have sufficient funds in the above reference account to cover the amount of the bill.
Signature

Clear
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