Fillable CALVERT CITY MUNICIPAL WATER & SEWER

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CALVERT CITY MUNICIPAL WATER & SEWER

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CALVERT CITY MUNICIPAL WATER & SEWER
AUTOMATIC WITHDRAWAL
Please complete the information below to be set up with automatic withdraw for your
Calvert City Municipal Water Bill.
Bank Account #: _______________________________________________________________________
What Type of Account:__________________________________________________________________
Bank Routing Number:___________________________________________________________________
Bank Name:____________________________________________________________________________
Name on Account:______________________________________________________________________
Water and Sewer Account Number:______________________________________________________
Phone Number:_________________________________________________________________________
By signing above you are giving the city of Calvert City Municipal Water & Sewer the
authority to automatically debit your account monthly for the current utility bill.
Automatic withdrawal will take place on the 5th of the month to avoid a late penalty of
15% on your utility bill.
A $20.00 fee will be charged for all non-sufcient accounts as well as disconnect/
reconnect fee of $35.
When an non-sufcient account occurs it may lead to the termination of your automatic
bank draft. Automatic withdrawal takes one month to process. Please pay close attention
to your water bill statement.
Signature:_________________________________________Date:________________________________
Witnessed by:_____________________________________ Date:________________________________
P.O. Box 36, 861 E 5th Ave, Calvert City, KY 42029 - (270) 395-7138 - info@calvertcity.com
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CALVERT CITY MUNICIPAL WATER & SEWER

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Completed 12 November 2021

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