Automatic Bill Payment Authorization
Authorize automatic payments for your Benton Utilities account by completing the information below.
Benton Utilities Account Number
*
Name(s) on Benton Utilities Account
*
Home Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Financial Institution
*
Financial Institution Address
*
City
*
State
*
Zip Code
*
Financial Institution Bank Transit/ABA Number
*
Bank Account Number
*
Account Type
*
Checking
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: