BANK DRAFT (ACH) AUTHORIZATION FORM
The City of Pasadena offers an easy and convenient way to pay your water bill. Our Bank Draft service allows you to
have your bill paid automatically by direct deduction from your bank account. Bank Draft saves you time and ensures
that your bill is paid on time, even when you’re out of town. You will continue to be provided a monthly statement
showing your current charges. Because payment is automatic, there are no late fees or postage costs. This service is
provided to you free of charge.
INSTRUCTIONS:
• Complete the authorization form below; to authorize payment from your checking/savings account, provide
account information along with a blank check marked VOID.
• Payments will be deducted from your checking/savings account on the due date or the first business day
following the due date; if we receive two (2) returned bank drafts as unpaid for any reason, you will be taken off
the bank draft program.
• The first automatic draft may take up to thirty (30) days from receipt of this authorization form.
• You may cancel this plan at any time by completing a “Bank Draft Cancellation Form”.
_____________________________________________ _____________________________________
Customer Name (as it appears on your bill) Account Number (as it appears on your bill)
______________________________________________ _______________________
Service Address Daytime Telephone Number
______________________________________________
Email Address
Bank Information: Type of Account: ______ Checking ______ Savings _____________________________________________
Bank Name
____________________________ ___________________________ _________________________________________
Bank ABA Routing Number Bank Account Number Name on Bank Account
I authorize the City of Pasadena to withdraw from the bank account indicated above, my monthly amount due for utility services.
I understand that the City of Pasadena may terminate this automatic payment plan if the City receives two (2) returned bank
drafts. I also understand that at any time I may elect to discontinue my enrollment in this plan by completing and submitting a
“Bank Draft Cancellation Form”.
____________________________________________ ____________________________
Signature (of bank account holder) Signature Date
City of Pasadena – Water Billing Office
1202 Southmore Ave
PO Box 1337
Pasadena, TX 77501-1337
713.475.5566 – Office
713.475.4945 - Fax
wbcs@pasadenatx.g
ov
To ensure the highest level of security regarding your bank information, our preferred method of receiving a
voided check is to deliver it in person to our office or place it in our night drop. We will accept
and emailed, faxed or mailed version of your voided check; however, you are responsible for contacting
the
Water Billing Office to ensure receipt of your information.
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
