CITY OF SOCORRO
P.O. Box K
Socorro, NM 87801
PHONE: 575-835-0240
FAX: 575-838-4027
Authorized Agreement for Preauthorized Payments
for
City of Socorro Utility Bill
To ensure proper ban coding of your transfer, please ATTACH A CHECK
marked “VOID” or provide us with you complete saving, checking or
credit union account number.
DEPOSITORY NAME BRANCH
CITY STATE ZIP CODE
TRANSIT/ABA NO. ACCOUNT NO.
DATE OF DEBIT 15
TH
OF EVERY MONTH
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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