CITY OF SAINT PETER UTILITIES
AUTHORIZATION FOR AUTOMATIC PAYMENTS
I AUTHORIZE THE CITY OF SAINT PETER’S FINANCE DEPARTMENT AND THE BANK NAMED
BELOW TO INITIATE VARIABLE ENTRIES TO MY CHECKING/SAVINGS ACCOUNT FOR PAYMENT
OF MY UTILITY BILL. THESE ENTRIES WILL BE MADE ON THE DUE DATE (USUALLY THE 15
TH
) OF
EACH MONTH. THIS AUTHORIZATION WILL REMAIN IN EFFECT UNTIL I NOTIFY THE CITY TO
CANCEL IT IN SUCH TIME AS TO AFFORD THE CITY A REASONABLE OPPORTUNITY TO ACT ON
IT.
CUSTOMER NAME (PLEASE PRINT) UTILITY ACCOUNT NUMBER
SERVICE ADDRESS PHONE NUMBER
BANK NAME
BANK ADDRESS (STREET, CITY, STATE & ZIP CODE)
BANK ROUTING NUMBER ACCOUNT NUMBER
AUTHORIZED SIGNATURE DATE
AUTOMATIC PAYMENT - You have the option of paying your bill by automatic bank payment
at no additional charge to you. Automatic payment will deduct your utility bill payment from your
bank account. You will still receive a copy of your utility bill the first of each month from our
office. Once your utility account is set up for automatic payment your bill will reflect the statement
“DO NOT PAY – PAID BY DRAFT.” The payment will be deducted from your bank account on
the due date indicated on the bill.
If you would like to take advantage of this option, please print and fill out the Authorization for
Automatic Payment Form above and return it to the Finance Department at City Hall or mail to the
City
of Saint Peter Finance Dept., 227 S. Front St., Saint Peter, MN 56082 by the eighth of the
month to have your payment withdrawn that month. If you would like the automatic payment to start
the next month please note that on the form
.
IS IT A CHECKING ACCOUNT OR SAVINGS ACCOUNT
Please mail the form or use the drop box at this time.
click to sign
signature
click to edit
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