Authorization to Honor Bank Drafts

Water Department Account Information

Account Number

Phone Number

Bank Account Information

Name of Bank

Bank Route Number

Bank Account Number

Authorization to Automatically Draft Bank Account

Dear Sir:

I hereby grant permission for the City of Bay City to draft my bank account each month for the City Utility Bill.

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First Name

Last Name

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Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.