CITY OF SOCORRO
P.O. Box K
Socorro, NM 87801
PHONE: 575-835-0240
FAX: 575-838-4027
Authorized Agreement for Preauthorized
Debit or Credit Card Payments
for
City of Socorro Utility Bill
I (we) hereby authorize the City of Socorro, hereinafter call COMPANY,
to initiate debit entries to my (our) Credit Card account indicated below
and the depository named below hereinafter call DEPOSITORY, to debit
the same to such account.
TYPE OF CARD: VISA OR MASTERCARD
ACCOUNT NUMBER
EXPIRATION DATE
DATE OF DEBIT: 5
TH
OR 20
TH
The authority is to remain in full force and effect until COMPANY AND
DEPOSITORY have received written notification from me (or either of us)
of its termination in such time and in such manner as to afford COMPANY
AND DEPOSITORY a reasonable opportunity to act on it.
NAME(S)
IB/UB ACCOUNT NUMBER
DATE PHONE NUMBER
SIGNED X SIGNED X
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