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City of Bay City, Texas Utility Billing Department

cparada@cityofbaycity.org

1901 Fifth St.

979-245-2322

Form Section 1

Authorization to Honor Bank Drafts

Water Department Account Information

Name
Address *

Bank Account Information

Authorization to Automatically Draft Bank Account

Dear Sir:

I hereby grant permission for the City of Bay City to draft my bank account each month for the City Utility Bill.

Sign Here *
Date *