Fillable Bank Draft Authorization Water Dept - BANKDRAFT AUTHORIZATION

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Bank Draft Authorization Water Dept - BANKDRAFT AUTHORIZATION

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The Bank Draft Authorization Water Dept - BANKDRAFT AUTHORIZATION form is 1 page long and contains:

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  • 2 check-boxes
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Country of origin: US
File type: PDF

U.S.A. forms for City of Oak Park

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I authorize the City of Oak Park, Michigan to withdraw the amount due for Water Usage to a
designated financial institution and account listed below. This authorization will also allow the
City to adjust entries to correct errors.
This authority will remain in effect until I have changed it in writing. I also understand that the
enrollment/changes authorized will become effective with the first billing period possible, based
on the processing time of the Water Department.
__________________________________________ ______________________________
SIGNATURE DATE
******************************************************************************
Please print the information requested below and return the completed form along with a
blank “voided” check to
:
The City of Oak Park Water Department
14000 Oak Park Blvd.
Oak Park, MI 48237
__________________________________________________
Name
______________________________________________________________________________
Address Telephone
__________________________________________________
Financial Institution Name
__________________________________________________
Address of Financial Institution
______________________________________________________________________________
City State Zip
SAVINGS
CHECKING
******************************************************************************
FOR OFFICE USE ONLY
TRANSIT ROUTING NUMBER ACCOUNT NUMBER
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Bank Draft Authorization Water Dept - BANKDRAFT AUTHORIZATION

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Completed 6 November 2019

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