Lancaster County
Water & Sewer District “Serving Lancaster County For Over 50 Years”
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P.O. Box 1009 – Lancaster, South Carolina 29721
Phone 803-285-6919 – Fax 803-285-9574
AUTHORIZATION TO: START BANK DRAFT CHANGE BANK DRAFT
I hereby authorize Lancaster County Water & Sewer District (LCWSD) to initiate debit entries,
or such adjusting entries, (debit or credit) which are necessary for corrections, to my
(Check one box) Checking or Savings account indicated below. I further authorize the Financial
Institution named below, to debit (or credit) the same to such account.
* A VOIDED CHECK OR LETTER FROM BANK SHOWING YOUR TRANSIT NUMBER AND
ACCOUNT NUMBER MUST BE INCLUDED TO DRAFT OUT OF THE CHECKING ACCOUNT
NEW FINANCIAL INSTITUTION INFORMATION:
FINANCIAL INSTITUTION NAME: _____________________________________________________
CITY: ___________________________ STATE: ___________________ ZIP: _________________
TRANSIT/ABA NUMBER: __________________ ACCOUNT NUMBER: _______________________
This authority is to remain in full force and effect until LCWSD has received its Authorization to Stop
Bank Draft Form from me of its termination in such time and in such manner as to afford LCWSD
a reasonable opportunity to act on it.
CUSTOMER INFORMATION:
CUSTOMER NAME: _______________________________________
CUSTOMER ACCOUNT NUMBER: ____________________________
_______________________________________ ____________________
CUSTOMER SIGNATURE DATE
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OFFICE USE ONLY BELOW
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RECEIVED BY DATE
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POSTED BY DATE PRENOTE: MONTH/YEAR
