Fillable AUTHORIZATION for ELECTRONIC BILL PAYMENTS SANBORN MUNICIPAL UTILITIES (City of Sanborn)

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AUTHORIZATION for ELECTRONIC BILL PAYMENTS SANBORN MUNICIPAL UTILITIES (City of Sanborn)

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U.S.A. forms for City of Sanborn

BROWSE CITY OF SANBORN (IA) FORMS

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SANBORN MUNICIPAL UTILITIES
102 Main Street - P.O. Box 548
Sanborn, IA 51248-0548
Office: 712-930-3842
FAX: 712-930-3060
AUTHORIZATION for ELECTRONIC BILL PAYMENTS
I/We hereby authorize Sanborn Municipal Utilities to initiate debit entries to my/our
Check one only ( ) Checking Account #
( ) Savings Account #
*ROUTING NUMBER
*Routing number may be supplied by your financial institution or you may attach a voided check or deposit slip to this form.
AT:
BANK NAME BRANCH
CITY STATE ZIP
Hereinafter called Depository, and to debit the same to such account on:
( ) 1st of month ( ) 8th of month ( ) 15th of month
This authorization is to remain in full force and effect until Sanborn Municipal Utilities has received written notification from me
(or either of us) of its termination in such time and in such manner as to afford Sanborn Municipal Utilities and Depository a
reasonable opportunity to act on it.
NAME(S)
DATE SIGNED X
DATE SIGNED X
SANBORN SAVINGS BANK - DEPOSIT TO:
Sanborn Municipal Electric General Fund
Account # ________________________
Word/Docs/Blank Forms/Electronic Bank Pay Authorization
For Company Use Only:
Effective Date: ________ / ________ / ________
Copy to Sanborn Savings Bank: ________ / ________ / ________
Customer Account # with Sanborn Municipal Utilities: _________
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AUTHORIZATION for ELECTRONIC BILL PAYMENTS SANBORN MUNICIPAL UTILITIES (City of Sanborn)

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Completed 16 July 2020

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