City of Manassas Authorization Agreement for ACH Bank Draft Debit for Real Estate Taxes

Authorization Agreement for ACH Bank Draft Debit for Real Estate Taxes

City of Manassas Treasurer's Office
City of Manassas Office of the Treasurer

P.O. Box 512, Manassas, VA 20108
I hereby authorize the CITY OF MANASSAS to initiate debit entries to my checking account indicated below and the bank named below to debit the same to such account.
Bank name:*
City:*
State, Zip Code:*
ROUTING/ABA #*
BANK ACCOUNT #*
Upload a photo/file of a voided check here.*

Cancelof
This authority is to remain in full force and effect until the City of Manassas Treasurer's Office has received written notification from me of its termination in such time and in such manner as to afford the City of Manassas a reasonable opportunity to act on it.

ACH debits will occur on the bi-annual due dates of June 5th and December 5th.
Real Estate Account #*
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Name*

First NameLast Name
Date*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Signature*

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Authorization Agreement for ACH Bank Draft Debit for Real Estate Taxes