Lee County Utilities
Automatic Payment Authorization Form
7391 College Parkway
Fort Myers, Florida 33907
Phone: (239)533-8845 or 1-800-485-0214
Fax: (239) 485-8845
Please complete this form in its entirety:
Customer Name:
Customer LCU Account No:
Customer Service Address:
Customer Daytime Phone:
Customer Information
Banking Information
Financial Institution Name:
Financial Institution Address:
Financial Institution Phone:
Bank Routing # (9 Digit):
Bank Account #:
Lee County Utilities will print a message on your bill to confirm your enrollment in the ACH program. It takes four (4) to six (6) weeks to
complete the enrollment process. Continue to pay your bill as you normal would until you receive a message on your bill confirming
enrollment. You may discontinue your enrollment in the ACH program whenever you would like but Lee County Utilities must receive your
notification four (4) working days before your bill due date. If your request is received after that time, enrollment will be cancelled for the next
monthly billing cycle. To cancel your enrollment, contact customer service at (239) 533-8845 or at 1-800-485-0214.
I hereby authorize Lee County Utilities to begin debiting my account for services rendered. In the unlikely event that a charge is posted to my
account in error, I authorize Lee County Utilities to make the necessary corrections. This authorization is to remain in effect until I notify Lee
County Utilities of its termination. My notification must afford the bank reasonable opportunity to act on it. Lee County Utilities and the bank
may terminate this agreement with written notice:
Signature: Date:
Please attach a voided check or savings deposit slip to this form and mail it to: 7391 College Pkwy Ft. Myers, Fl 33907
Checking Savings
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