ATTACH VOIDED CHECK HERE
Employee Signature:
Processed Date:
(OFFICE USE)
Account
Number:
What is an ACH Draft? ACH Draft lets you authorize the payment of your Utility Bill directly from your
Bank Account.
How will I know the amount being deducted from my account? You will still receive a copy of your
bill for your records. If you have any questions or concerns regarding your bill, please contact the Utility
Department at 936-597-3275.
When will my bill be paid? ACH Draft is deducted from your bank account the business day before
the due date.
I authorize The City of Montgomery to initiate entries to my bank account at the financial institution (First Financial
Bank), and if necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in
effect until The City of Montgomery is notified by me in writing to cancel the agreement in such time as to afford The City
of Montgomery and financial institution a reasonable opportunity to act on it. To avoid a late charge, it is your
responsibility to inform the City of Montgomery of a change to your bank account information.
Applicant Signature:
Date Completed: Print Name:
SERVICE ADDRESS:
NAME ON BANK ACCOUNT:
FINANCIAL INSTITUTION:
BANK ROUTING #:
BANK ACCOUNT #:
UTILITY ACH/ BANKING AGREEMENT
City of Montgomery
101 Old Plantersville Rd, Montgomery Texas 77316
(936)-597-6434 www.montgomerytexas.gov
click to sign
signature
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