AUTOMATIC DRAFT AUTHORIZATION
HARKER HEIGHTS WATER DEPARTMENT 305 MILLER’S CROSSING HARKER HEIGHTS TX 76548
Name: Phone Number:
Service Address: Account Number:
Complete ONLY ONE option below. Check here if you are making a change to a draft.
OPTION 1: CREDIT/DEBIT CARD DRAFT
Credit/Debit Card Number:
Credit/Debit Card Type: VISA MasterCard Discover AMEX Exp Date for Credit Card:
Name as it Appears on Credit Card:
Billing Address/Zip Code for Credit Card:
OPTION 2: BANK ACCOUNT DRAFT
A voided check or bank card copy is REQUIRED for drafts from a bank account.
Name(s) on Account:
Bank Name:
Bank Routing Number: Bank Account Number:
Please initial by each applicable statement:
ALL DRAFTS: I authorize the City of Harker Heights to draft the account indicated above to pay my monthly
utility bill. I understand that the account will be drafted for the total amount due on the due date referenced on my bill.
ALL DRAFTS: I understand that I must make payments on my account until “PAID BY CREDIT CARDOR
“PAID BY DRAFT” appears on my City of Harker Heights utility bill. Failure to do so could result in late fees.
ALL DRAFTS: I understand that this authorization will remain in effect until the City of Harker Heights
receives written notification of its termination.
BANK DRAFTS ONLY: I understand that I must pay my current bill and the next bill in order to allow time for
my bank draft to be set up/updated. Bank drafts have to be pre-noted which can take up to one billing cycle. Updating a
draft removes the draft that was initially in place and requires the need for a pre-note to be done again.
BANK DRAFTS ONLY: I understand that if my draft is returned for insufficient funds or closed accounts I will
be charged a fee of $30. I will also no longer be permitted to have my account drafted nor pay by check for six months.
After six months, I will need to submit a new automatic draft authorization in order to start drafts again.
CREDIT CARD DRAFTS ONLY: I understand that I am responsible for providing accurate information
concerning my credit card account and for contacting the Harker Heights Water Department with any changes to include
the name on the card, credit card number, billing address, and/or expiration date. Failure to provide accurate information
could cause the card to decline the charge and I will be responsible for making a payment in another form to include any
late fees applied. After my draft is returned two times, the draft will be removed from my account and I will need to make
payments on my account as usual.
Signature ______________________________________________________________ Date:
Print Form
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome