Fillable Piedmont Municipal Authority Utility Account Bank Draft Authorization (CITY OF PIEDMONT)

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Piedmont Municipal Authority Utility Account Bank Draft Authorization (CITY OF PIEDMONT)

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Piedmont Municipal Authority
Utility Account Bank Draft Authorization
Name: _____________________________________________________________
Address: ___________________________________________________________
I hereby authorize the Piedmont Municipal Authority to automatically draft my
bank account described below for my monthly utility service charges. If any
information regarding the draft authorization changes, I am responsible for
notifying the Piedmont Municipal Authority.
Please include a voided check or deposit slip.
___________________________________________________________________
Signature
Routing Number: ____________________________________________________
Account Number: ____________________________________________________
Bank Name and Address:
___________________________________________________________________
___________________________________________________________________
*******************************************************************
Office Use Only
Utility Account Number: ______________________________________________
Posted By/Date: _____________________________________________________
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Piedmont Municipal Authority Utility Account Bank Draft Authorization (CITY OF PIEDMONT)

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Completed 14 July 2020

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