- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - CUT HERE, KEEP THE UPPER PORTION FOR YOUR RECORDS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
AUTHORIZATION AGREEMENT FOR UTILITY BANK DRAFTING PROGRAM
NAME ON UTILITY ACCOUNT: ____________________________________
SE
RVICE ADDRESS: _______________________________________________
NAME
OF FINANCIAL INSTITUTION: _______________________________
BRANCH
ADDRESS: _______________________________________________
UTILITY ACCOUNT NO.: ______________________________
CUSTOMER PHONE NO:. ( ) _____________________
CHECKING ACCOUNT NO.: ____________________________
ROUTING NO.: ________________________________________
__
______
________________________________________ ______________________________________ ________________
Authorized Signature Customer Name (Print) Date
Utility Billing Bank Draft Form
99 East Ramsey Street, PO Box 985, Banning, CA 92220
Tel: (951) 922-3185 Fax: (951) 922-3165 Email:ubweb@banningca.gov
www.banningca.gov
As a City of Banning utilities customer, you can simplify your life by paying your monthly utility bill directly from
your bank account. The City of Banning offers a convenient and secure automatic bank drafting service; this service is
free of charge to all Banning residents and businesses. Sign up today and avoid long lines, late payments, writing checks
and using stamps!
To sign up for Utility Billing Bank Drafting, simply:
1. Complete the authorization form at the bottom of this page.
2. Attach a "voided" check of your bank account or proof of bank account information (no deposit slips).
3. Return both the form and voided check or proof of bank account information to the City of Banning, Utility Billing
Department by mail or in person. (If you have more than one account with the City, please contact Customer
Service before enrolling in Bank Drafting).
Program Guidelines:
• It may take 1 to 2 billing cycles to process your initial enrollment in the program, depending on when your
application is submitted.
• You should continue to pay any utility bills received until you see the "Your bank account will be drafted"
notation next to the amount due on your bill.
• After enrollment is complete, your bank account will automatically be debited on your due date each month.
Contact the Utility Billing Department at (951) 922-3185 if you have any questions or concerns about your bill
prior to your payment being processed.
• The payment will be presented to your financial institution once for processing. If the payment is returned by
your financial institution, you will be charged a returned check fee (currently $25 for the first returned item and
$35 for the second) and you will be required to make a cash or credit payment on your account.
• You will be terminated from the program and placed on "cash only" status after two payments have been returned
from the bank for non-payment. You may re-enroll in the program after one year.
• If you decide to discontinue participation in the Utility Bill Bank Drafting Program, you will need to fill out a
Bank Draft dis-enrollment form. (Dis-enrollment in the program may take 1-2 billing periods to process.)
**DON’T FORGET TO ATTACH PROOF OF BANK INFORMATION
OR A VOIDED CHECK TO THIS AUTHORIZATION FORM**
I hereby authorize the City of Banning and the financial institution indicated above to deduct from my checking account to pay
for my municipal utility bills. I acknowledge that the origination of Automatic Clearing House (ACH) transactions must comply
with the provisions of U.S. law. I understand that both the City of Banning and my financial institution reserve the right to
terminate this authorization and my participation therein. If I choose to terminate this authorization, I will immediately notify the
City of Banning.
_______
ROUTE NO.: ______
