Utility Automatic
Bank Draft Form
Enrolling in the City of Kannapolis Utility Automatic Bank Draft Plan is easy. Just complete this authorizing form
and return it to the Customer Service Center at MPresident@kannapolisnc.gov with a copy of a voided check
from the bank account you wish to be drafted. All subsequent bill payments will be automatically deducted
from your account on the due date shown on your monthly statement giving you enough time to review your
bill and if necessary contact the Customer Service office should you have any questions or concerns.
Customer Name: ________________________________________________________________________
(Joint Account include both names)
Service Address: ________________________________________________________________________
Mai
ling Address: _______________________________________________________________________
(If different)
Home Phone: _____________________________ Work Phone: _____________________________
Cell Phone: ______________________________ Email: __________________________________
Water/Sewer Account #s: _________________________________________________________________
This authority is to remain in full force and effect until CITY and DEPOSITORY has received written notification from me (or
either of us) of its termination in such time and in such manner as to afford CITY and DEPOSITORY a reasonable opportunity
to act on it. I (either of us) have the right to stop payment of a debit entry by notification to DEPOSITORY at such time as to
afford DEPOSITORY a reasonable opportunity to act on it prior to charging account. After account has been charged, I have the
right to have the amount of an erroneous debit immediately credited to my account by DEPOSITORY, provided I (we) send
written notice of such debit entry in error to DEPOSITORY within 15 days following issuance of the account statement or 45
days after posting, whichever occurs first.
Bank Information
Banking Institution Name: _________________________________ Bank Branch: ________________
Bank Routing No.: ___________________________ Bank Account No.: ___________________________
**Customer Signature: ___________________________________________ Date: __________________
**Customer Signature: ___________________________________________ Date: __________________
(Joint Account include both signatures)
If you have questions, contact the Customer Service Center at: 704-920-4399, visit the office at 401 Laureate Way,
Kannapolis, NC 28081, or via email at MPresident@kannapolisnc.gov.
OFFICE USE ONLY
Cycle #: ______________________________
Received By & Date: ____________________
Entered By & Date: _____________________
** Note: Electronic signatures are accepted.
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