Fillable ? Bank Draft Authorization (City of Aztec)

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? Bank Draft Authorization (City of Aztec)

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The ? Bank Draft Authorization (City of Aztec) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for City of Aztec

BROWSE CITY OF AZTEC (NM) FORMS

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1
WHO ARE
UTILITY ACCOUNT NUMBER
YOU?
CUSTOMER NAME
CUSTOMER ADDRESS
CUSTOMER'S HOME PHONE NO./DAY TIME PHONE NO.
2 SELECT ONE:
TYPE OF ACCOUNT:
(SELECT ONE)
TYPE OF
AUTHORIZATION Initial Authorization CHECKING
Change OR
Cancellation of Authorization
SAVINGS
3 PLEASE CONTACT YOUR BANK FOR THIS INFORMATION. INCORRECT INFORMATION
ACCOUNT WILL DELAY UTILITY BANK DRAFT PROCESSING.
INFORMATION
ACCOUNT NUMBER
NAME AND ADDRESS OF FINANCIAL INSTITUTION
ROUTING NUMBER
BANK'S PHONE NUMBER
4 I hereby authorize the City of Aztec to pay and charge to my (our) account all bills
CUSTOMER for utilities and miscellaneous services rendered against the undersigned by the City of
AUTHORIZATION
Aztec. I understand this authorization will remain in force until the City has received
written notification of termination or change and allow the City sufficient time to
process same notification.
Customer Signature Date
(Must be the same as on bank signature card)
RETURN FORM TO CITY OF AZTEC, UTILITY CUSTOMER SERVICE DEPARTMENT,
201 W CHACO, AZTEC, NM 87410
Please attach copy of voided check here
- -
UTILITY PAYMENT AGREEMENT FOR BANK DRAFTS
1.
2.
3.
Any completed bank draft authorization received after the 15
th
will be processed the following month.
4.
5.
6.
7.
8.
9.
THE UNDERSIGNED HAS READ AND AGREES TO THE ABOVE STATEMENTS.
APPLICANT SIGNATURE___________________________DATE______________
No insufficient fund bank drafts will be resubmitted to the City’s bank account and must be redeemed by the customer with
cash or cashier’s check.
Any customer experiencing two or more bank draft returns within a one year period will be placed on a “cash only” basis with
respect to making payments on his utility account and will be taken off bank draft status for one year.
Bank drafts will remain in force until the City has received written notification of termination or change and allow the City
sufficient time to process same notification.
Bank drafts will be available for all customers. (Exception: - Bank Draft service not available to customers on “cash only”
status)
A Bank Draft Authorization form must be completed. The deadline for the form to be completed is the 14
th
of each month in
order to have bank draft started for the next billing cycle. The first month we will run a test on each bank draft with the
bank to verify all information is correct, no amount will be drafted from your bank account until the second billing cycle. This
means you will need to make one more payment until your bank draft begins. Another way to know your amount due will be
drafted is your billing statement will read "DO NOT PAY" and bank draft will appear in the amount area.
Review your monthly utility bill. Should you feel your bill contains an error you must notify the Aztec Utility Office
immediately to hold the bank draft until the error is corrected. Otherwise, your payment will be drawn on the 10
th
of the
following month.
All customer bank drafts submitted, by the City, as payment for utility services are required to be covered by sufficient
funds in the bank account upon which the draft is drawn.
Any customer bank draft returned by the bank to the City due to non-sufficient funds will cause a $25.00 service charge to
be assessed to the customer.
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Bank Draft Authorization (City of Aztec)

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Completed 14 July 2020

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