Authorization to Honor Bank Drafts

Water Department Account Information

Account Number

Phone Number

Bank Account Information

Name of Bank

Bank Route Number

Bank Account Number

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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.

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.