OFFICE USE ONLY
CITY OF NORMAN BANK AUTHORIZATION FORM
YOUR PAYMENT WILL BE DRAFTED ON YOUR DUE DATE
__________________________________ ____________________________________
Please Print Utility Account Name Utility Account Number
________________________________________________________________________________________________
Service Address
_______________________________________________ _______________ _________________
Customer Phone Number Cycle Route
_______________________________________________ ________________ _____ _______________
Mailing Address City State Zip Code
________________________________________________________________________________________________
Name on Checking Account
Name of Bank ____________________________________________________________________________________
to charge my checking account the amount of monthly utility service bill payable to City of Norman.
P.O. Box 5599
____________________________________ ______________ Norman, OK 73070
Authorization Signature Date
N
ote: To e
nsure proper bank coding, please attach a voided blank check.