Fillable City of Sweeny Utility Billing Automatic Draft Authorization (City of Sweeny)

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City of Sweeny Utility Billing Automatic Draft Authorization (City of Sweeny)

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The City of Sweeny Utility Billing Automatic Draft Authorization (City of Sweeny) form is 1 page long and contains:

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  • 2 check-boxes
  • 10 other fields

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File type: PDF

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City of Sweeny
Utility Billing Automatic Draft
Authorization Form
102 W. Ashley Wilson Road, Sweeny, Texas 77480
(979) 548-3321 | FAX: (979) 548-7745 | sweenytx.gov
I authorize The City of Sweeny to automatically deduct recurring monthly payments for my utility bill from my
checking/savings account.
This authority will remain in effect until The City of Sweeny has received written notification from me of its
termination at least ten (10) business days before the next scheduled payment.
Customer Name: _________________________________ Utility Account Number: _____________________
Customer Address: __________________________________________________________________________
Financial Institute Name: _____________________________________________________________________
Financial Institute Routing Number: ____________________________________________________________
Financial Institute Account Number: ___________________________________________________________
Name on Bank Account: ____________________________________ Checking Savings
Attached copy of voided check: Yes No
It is my responsibility to provide and maintain the most up to date and accurate financial information shown
above.
Customer Signature: ________________________________________ Date: __________________________
City Employee Signature: _____________________________________________________________________
***** Please note automatic draft will occur on the 10th of each month. *****
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City of Sweeny Utility Billing Automatic Draft Authorization (City of Sweeny)

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Completed 16 July 2020

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